糖尿病合并尿路感染患者尿液降钙素原水平及其临床意义

目的:探讨糖尿病合并尿路感染患者尿液降钙素原(PCT)水平及其临床意义。方法:选取2017年8月至2018年12月中山大学附属第五医院内分泌与代谢病科收治的糖尿病患者78例,以其中合并真性细菌尿者39例作为观察组,未合并尿路感染39例作为对照组,比较两组患者的临床资料以及相关实验室检查结果,同时留取尿液标本,观察组分别留取使用抗生素治疗前、后的尿液标本。采用酶联免疫吸附测定(ELISA)法检测尿液PCT浓度。分别比较观察组与对照组以及观察组治疗前后的尿液PCT水平,分析尿液PCT水平对于诊断糖尿病合并尿路感染的临床价值。结果:观察组尿液PCT水平为0.030 (0.025,0.039) ng/m L,明显高于对照组0.017 (0.011,0.021) ng/m L(P0.05);观察组有症状尿路感染与无症状细菌尿(ABU)的尿液PCT水平比较差异无统计学意义(P0.05),但其均显著高于对照组(P0.05);观察组使用抗生素治疗后的尿液PCT水平为0.031 (0.025,0.040) ng/mL,与治疗前相比较差异无统计学意义(P0.05)。尿液PCT对糖尿病合并尿路感染诊断的敏感度为82.05%,特异度为79.49%,阳性预测值为80.00%,阴性预测值81.58%,ROC曲线下面积为0.81 (95%CI为0.71-0.89, P0.0001)。结论:尿液PCT水平对糖尿病合并尿路感染有一定的诊断参考价值,但对于抗生素疗效的评估价值还需进一步深入研究。

Urine Procalcitonin Level in the Diabetes Mellitus Patients with Urinary Tract Infection and Its Clinical Significance

ABSTRACT Objective: To investigate the urine procalcitonin (PCT) level in the diabetes mellitus patients with urinary tract infection and its clinical significance. Methods: A total of 78 diabetes mellitus patients who hospitalized in the Department of Endocrinology and Metabolic Diseases of the Fifth Affiliated Hospital of Sun Yat-Sen University from August 2017 to December 2018 were enrolled in this study. 39 patients with positive of midstream urine culture were divided into observation group, while another 39 patients that without urinary tract infection were divided into control group. Compared the clinical record and examination results between both groups. Urine samples of both groups were collected, and in observation group were collected twice, which were before and after antibiotics treatment. Enzyme-linked immunosorbent assay (ELISA) was used for measuring concentration of PCT in urine. The urine PCT level of the observation group and the control group, and the observation group before and after treatment were compared. Analyzed the clinical value of urine PCT level in the diabetes mellitus with urinary tract infection. Results: The level of urine PCT of observation group was significantly higher than that in control group (P<0.05), whose median of PCT was 0.030 (0.025, 0.039) ng/mL and 0.017 (0.011, 0.021) ng/mL, respectively. There was no significant difference in level of urine PCT between symptomatic urinary tract infection and asymptomatic bacteriuria (ABU) in the observation group (P>0.05), but they were significantly higher than that in control group (P<0.05). The level of urine PCT in observation group was 0.031 (0.025, 0.040) ng/mL after treatment, however, there was no significant difference between before and after treatment (P>0.05). The sensitivity, specificity, positive predictive value and negative predictive value of urine PCT for diagnosing diabetes mellitus patients with urinary tract infection were 82.05 %, 79.49 %, 80.00 %, 81.58 %, respectively, and the area under the ROC curve was 0.81 (95 % CI was 0.71-0.89, P<0.0001). Conclusion: Urine PCT level has certain diagnostic reference value for diabetes mellitus with urinary tract infection, but the evaluation value of antibiotic efficacy needs further study.