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WBC、hs-CRP 与 PCT 在烧伤感染诊断及转归中的价值分析
Values of WBC，hs-CRP and PCT in the Diagnosis and Prognosis of Burn Infection

王猛,倪少俊,黄谦,张文广,吕炜亮,王成.WBC、hs-CRP 与 PCT 在烧伤感染诊断及转归中的价值分析[J].中国烧伤创疡杂志,2019,(5):330~335.

DOI：

英文关键词:White blood cell High-sensitivity C-reactive protein Procalcitonin Burn infection Diagnosis Prognosis

基金项目:

作者	单位
王猛	龙华区人民医院烧伤整形科
倪少俊	遵义医科大学第五附属
黄谦	龙华区人民医院烧伤整形科
张文广	龙华区人民医院烧伤整形科
吕炜亮	龙华区人民医院烧伤整形科
王成	遵义医科大学第五附属

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中文摘要:

【摘要】目的探讨白细胞 (WBC)、超敏 C 反应蛋白 (hs-CRP) 与降钙素原 (PCT) 在烧伤感染诊断及转归中的价值? 方法选取 2016 年 6 月至 2017 年 4 月深圳市龙华区人民医院及遵义医科大学第五附属 (珠海) 医院收治的 62 例烧伤感染患者与同期进行健康体检的 30 名健康体检者作为研究对象，经病原学检查后按照感染性质将烧伤感染者分为细菌感染组 (38 例) 与非细菌感染组 (24 例)，并将 30 名健康体检者设定为对照组，对比观察三组研究对象的 WBC 计数与 hs-CRP、PCT 水平变化情况，分析 WBC 计数与 hs-CRP、PCT 水平在烧伤感染诊断及转归中的价值? 结果 (1) 细菌感染组患者的 WBC 计数与 hs-CRP、PCT 水平均显著高于非细菌感染组与对照组，P 均 < 0.01，差异具有统计学意义；非细菌感染组患者的 hs-CRP 水平显著高于对照组，P < 0.01，差异具有统计学意义? (2) 细菌感染组患者中，Ⅱ度、Ⅲ度烧伤者 hs-CRP 与 PCT 水平均显著高于Ⅰ度烧伤者，P 均 < 0.05，差异具有统计学意义；Ⅲ度烧伤者 PCT 水平显著高于Ⅱ度烧伤者，P < 0.05，差异具有统计学意义? (3) WBC 计数诊断烧伤患者细菌感染的敏感度为 0.621、特异度为 0.582；hs-CRP 水平诊断烧伤患者细菌感染的敏感度为 0.694、特异度为 0.607；PCT 水平诊断烧伤患者细菌感染的敏感度为 0.817、特意度为 0.719? (4) 细菌感染组患者 PCT 水平与血培养结果的一致性检验结果显示，Kappa 值为 0.946，P 值为 0.000，说明在判断细菌感染时 PCT 水平与血培养结果一致? 结论 WBC 在烧伤患者细菌感染诊断中的价值不及 hs-CRP 与 PCT，且 PCT 在烧伤患者细菌感染的诊断中具有较强的敏感性与特异性，可作为诊断烧伤感染与判断烧伤转归的敏感指标?

英文摘要:

【Abstract】 Objective To explore the values of white blood cell (WBC)，high-sensitivity C-reactive protein (hsCRP) and Procalcitonin (PCT) in the diagnosis and prognosis of burn infection. Methods Sixty-two patients with burn infection and thirty healthy people undergoing physical examination in Longhua District People’s Hospital and The Fifth Affiliated Hospital of Zunyi Medical University (Zhuhai) during June 2016 and April 2017 were selected as subjects. The 62 patients were divided into a bacterial infection group (38 patients) and a non-bacterial infection group (24 patients) according to the nature of infection based on the pathogenic examination，and the 30 healthy people were set as a control group. The WBC count and the changes of hs-CRP and PCT were respectively observed and compared among the three groups，and also the values of the WBC count and the levels of hs-CRP and PCT in the diagnosis and prognosis were analyzed. Results (1) In the bacterial infection group，the WBC count and the levels of hs-CRP and PCT were all significantly higher than that in the non-bacterial infection group and the control group，and the differences were statistically significant，all P < 0.01. The level of hs-CRP in the non-bacterial infection group was markedly higher than that in the control group and the difference was also statistically significant，P < 0.01. (2) In the bacterial infection group，the levels of hs-CRP and PCT of patients with II degree and III degree burns were obviously higher than that of patients with I degree burns，and the differences were statistically significant，P < 0.05. And also the PCT level of patients with III degree burns was markedly higher than that of patients with II degree burns，which also showed a statistically significant difference，P < 0.05. (3) The sensitivity of WBC count in diagnosing bacterial infection of burn patients was 0.621，and the specificity was 0.582. And the sensitivities of hs-CRP and PCT in diagnosing bacterial infection of burn patients were respectively 0.694 and 0.817，and the specificities respectively 0.607 and 0.719. (4) The results of the consistency test between PCT level and blood culture results in the bacterial infection group showed that Kappa value was 0.946 and P = 0.000，which indicated that PCT level was consistent with the blood culture results in determining bacterial infection. Conclusion In the diagnosis of bacterial infection of burn patients，the value of WBC was inferior to that of hs-CRP and PCT. PCT，presenting strong sensitivity and specificity in diagnosing the bacterial infection of burn patients，can be used as a sensitive indicator for the diagnosis of burn infection and the evaluation of burn prognosis.