全科医学临床与教育

目的 分析维持性血液透析（MHD）患者导管相关性血流感染（CRBSI）情况及C反应蛋白（CRP）、降钙素原/白蛋白（PCT/ALB）、淀粉样蛋白A(SAA)的检测价值。方法 选取MHD患者90例，分析其CRBSI情况，依据是否发生CRBSI分为发生CRBSI组、未发生CRBSI组，对比其临床资料及CRP、PCT/ALB、SAA，绘制受试者工作特征（ROC）曲线评估CRP、PCT/ALB、SAA对CRBSI的预测价值。结果 90例MHD患者中，发生CRBSI 14例，感染率为15.55%，共分离出18株病原菌，其中革兰阴性菌、革兰阳性菌分别占比44.45%(8/18)、55.55%(10/18)，以金黄色葡萄球菌占比最高（8株，44.45%）。发生CRBSI组CRP、PCT、PCT/ALB、SAA均高于未发生CRBSI组，ALB低于未发生CRBSI组（t=41.99、34.62、39.55、2.67、-6.06,P均<0.05）。ROC显示，CRP、PCT/ALB、SAA联合预测MHD患者发生CRBSI的灵敏度、特异度、曲线下面积分别为86.32%、78.89%、0.88(95%CI 0.83～0.93)，其曲线下面积均高于各指标单独预测结果（Z分别=3.45、2.77、2.53,P均<0.05）。结论 MHD患者CRBSI发生率高，监测CRP、PCT/ALB、SAA对于判断其CRBSI风险有重要临床意义。

Objective To analyze the status of catheter-related bloodstream infection(CRBSI)in maintenance hemodialysis(MHD)patients,and the detection value of C-reactive protein(CRP),procalcitonin/albumin(PCT/ALB)and serum amyloid A(SAA). Methods A total of 90 MHD patients were selected.According to the status of CRBSI,they were divided into CRBSI group and non-CRBSI group.Clinical data,CRP,PCT/ALB,and SAA were compared between the two groups.The correlation of CRP,PCT/ALB,and SAA in patients with CRBSI was analyzed.The predictive value of CRP,PCT/ALB,and SAA for CRBSI was evaluated using the receiver operator characteristic(ROC) curve. Results Of 90 patients with MHD,14 cases occurred CRBSI,with an infection rate of 15.55%.A total of 18 pathogenic bacteria strains were isolated,of which Gram-negative bacteria and Gram-positive bacteria accounted for 44.45%(8/18)and55.55%(10/18),respectively.The proportion of Staphylococcus aureus was the highest(8 strains,44.45%).CRP,PCT,PCT/ALB,and SAA in the CRBSI group were higher than those in the non-CRBSI group,while the ALB in the CRBSI group was lower than that in the non-CRBSI group(t=41.99,34.62,39.55,2.67,-6.06,P<0.05).ROC curve analysis showed that the sensitivity,specificity and area under the curve of combination of CRP,PCT/ALB and SAA for predicting CRBSI in MHD patients were 86.32%,78.89% and 0.88(95%CI 0.83-0.93).The area under the curve was greater than that of prediction with a single indicator(Z=3.45,2.77,2.53,P<0.05). Conclusion The incidence of CRBSI is high in MHD patients.Monitoring CRP,PCT/ALB and SAA is of positive significance for judging the risk of CRBSI.