早期發現感染、確認感染之微生物、正確使用抗生素，在治療敗血症時至為重要。定量性即時聚合酶鏈鎖反應是一種可能加速確認感染微生物的檢驗，以及其敏感性與正確性的技術。在本研究中我們使用此方法，嘗試偵測全身性發炎反應症候群（systemic inflammatory response syndrome，SIRS）之急診病人血流中，來自腸道的菌株。所使用的primer為針對23S ribosomal DNA 與 wec F 基因所設計。
結果發現在SIRS病人中，至急診求診後十天內所採樣檢體中培養出微生物的病人、於二十八天內死亡的病人，其血液中來自腸道的革蘭氏陰性桿菌DNA量較高。而合併休克的病人、符合SIRS定義中之呼吸項目與白血球項目的病人，以及符合SIRS定義中之呼吸項目與白血球項目且疾病較為嚴重（APACHE II分數大於20分）的病人，其血液中來自腸道的革蘭氏陰性桿菌DNA量較高，且於二十八天時的死亡率也較高。由此顯示SIRS病人體內可能發生了細菌轉位的情形，且可能與病人之較高的死亡率有關。

Early detection of infection, identification of microorganism, and correct choice of antibiotics are critical in the management of sepsis. Quantitative real-time polymerase chain reaction (RT-PCR) has the potential to improve the timeliness, sensitivity, and accuracy of detecting pathogens. In this study we utilize this method to detect the enteric bacterial counts in the blood from patients with systemic inflammatory response syndrome (SIRS) in the emergency department (ED). The universal primers utilized in RT-PCR are specific for 23S ribosomal DNA (rDNA) and wec F gene. The results show that in SIRS patients with positive culture results from specimen collected within 10 days after presenting to ED, and patients surviving for less than 28 days, the serum bacterial DNA load of enteric Gram negative bacilli is higher. In SIRS patients with shock, patients fulfilling both white blood cell counts and respiratory criteria of SIRS, and patients fulfilling both white blood cell counts and respiratory criteria of SIRS with Acute Physiology and Chronic Health Evaluation II score more than 20, the serum bacterial DNA load of enteric Gram negative bacilli and 28-day mortality are both higher. These results suggest that bacterial translocation may happen in patients with SIRS and may be related to higher mortality in patients with SIRS.

Abstract in Chinese iv
Abstract in English v
Introduction 1
Materials and Methods 2
Results 4
Discussion 11
Figures 18
Tables 45
References 54

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