微滴式数字PCR、CRP、PCT、NLR联合检测对细菌性血流感染的诊断价值

Diagnostic value of combined detection of droplet digital PCR, CRP, PCT and NLR for bacterial bloodstream infections

    摘要
  • 摘要:
    目的  探讨微滴式数字聚合酶链式反应(ddPCR)联合C-反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞与淋巴细胞比值(NLR)检测对细菌性血流感染的诊断价值。
    方法  选取2023年1月-2024年6月广西壮族自治区江滨医院收治的疑似血流感染患者为研究对象，共纳入543例患者的993份标本。根据ddPCR和血培养(BC)结果分为BC+和/(或)ddPCR+组(424份)、ddPCR-/BC-组(569份)。根据ddPCR检测菌种分为单一感染组(258份)，混合感染组(160份)和ddPCR-组(575份)。比较各组CRP、PCT和NLR水平，采用受试者工作特征(ROC)曲线评估ddPCR、CRP、PCT和NLR单独及联合诊断细菌性血流感染的效能。
    结果  BC+和/(或)ddPCR+组CRP、PCT、NLR分别为71.61(37.00, 108.81)mg/L、1.74(0.47, 7.93)ng/ml、9.82(5.53, 18.07)，高于ddPCR-/BC-组(P＜0.001)。ddPCR混合感染组CRP、PCT水平分别为88.02(42.90，112.39)mg/L、2.83(0.89，12.35)ng/ml，高于单一感染组(P＜0.05)。ddPCR定性结果预测血流感染较好(OR=15.279，95%CI：6.525~35.776，P＜0.001)。在ROC曲线分析中，单项检测指标中ddPCR的曲线下面积(AUC)最大(0.759)，其次为PCT(0.732)。ddPCR定性结果与CRP、PCT、NLR联合的AUC为0.830，联合检测诊断效能优于单项指标。
    结论  ddPCR联合PCT、CRP、NLR可提高细菌性血流感染诊断的准确性。ddPCR较血培养具有更高敏感度，可快速明确血流感染病原菌种类及浓度。

     

    Abstract:
    OBJECTIVE  To explore the diagnostic value of combined detection of droplet digital polymerase chain reaction (ddPCR), C-reactive protein (CRP), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) for bacterial bloodstream infections.
    METHODS  Patients with suspected bloodstream infections admitted to Jiangbin Hospital of Guangxi Zhuang Autonomous Region from Jan. 2023 to Jun. 2024 were selected as the study subjects, with a total of 993 specimens from 543 patients included. Based on ddPCR and blood culture (BC) results, the patients were divided into BC+ and/or ddPCR+ group (424 specimens) and ddPCR-/BC- group (569 specimens). The bacterial species detected by ddPCR were further classified into single infection group (258 specimens), mixed infection group (160 specimens) and ddPCR- group (575 specimens). The levels of CRP, PCT and NLR were compared among the groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of ddPCR, CRP, PCT and NLR separately and in combination for bacterial bloodstream infections.
    RESULTS  The levels of CRP, PCT and NLR in the BC+ and/or ddPCR+ group were 71.61 (37.00, 108.81) mg/L, 1.74 (0.47, 7.93) ng/ml and 9.82 (5.53, 18.07), respectively, which were higher than those in the ddPCR-/BC- group (P < 0.001). In the ddPCR mixed infection group, the levels of CRP and PCT were 88.02 (42.90, 112.39) mg/L and 2.83 (0.89, 12.35) ng/ml, respectively, which were higher than those in the single infection group (P < 0.05). The qualitative results of ddPCR were better at predicting bloodstream infections (OR=15.279, 95%CI: 6.525~35.776, P < 0.001). According to ROC curve analysis, ddPCR had the largest area under the curve (AUC) among the single detection indicator (0.759), followed by PCT (0.732). The AUC for the combination of ddPCR qualitative results with CRP, PCT and NLR was 0.830, indicating that the diagnostic performance of the combined detection was better than that of any single indicator.
    CONCLUSIONS  The combination of ddPCR with PCT, CRP and NLR can improve the accuracy of diagnosing bacterial bloodstream infections. Compared with BC, ddPCR has higher sensitivity and can quickly identify the types and concentrations of pathogens in bloodstream infections.

     

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