降钙素原对重症脑梗死合并肺部感染的早期诊断价值  

Procalcitonin:an early predictor of pulmonary infection in ischemic stroke

作　　者：孟宏涛[1] 马勇智[1] 何君宏[1] 杨爱华[1] 

机构地区：[1]武警陕西总队医院医务处,陕西西安710054

出　　处：《武警医学院学报》2011年第12期948-950,共3页Acta Academiae Medicinae CPAPF

摘　　要：【目的】探讨降钙素原(procalcitonin,PCT)对重症脑梗死合并肺部感染的早期诊断价值。【方法】30例急性脑梗死患者因意识障碍或合并重要脏器功能衰竭入住监护病房,根据临床表现分为合并肺部感染组和非感染组。所有患者入院当时、入院后第3天和第7天分别抽血检测PCT、C反应蛋白(C reaction protein,CRP)和白细胞(white blood cell,WBC)计数水平,同时行痰培养、胸片等检查,采用ApacheⅡ评估患者病情程度。随访28 d判断预后。【结果】PCT在肺部感染组尤其痰培养阳性患者升高明显,浓度高于0.5 ng/ml,诊断脑梗死合并肺部感染的敏感性为97%,特异性为91.7%,其阳性预测值达到82.1%,均高于CRP和WBC。ApacheⅡ评分高于20则PCT明显增高,CRP呈现增高趋势,但各组间无统计学差异。PCT的浓度与预后有关,死亡组明显高于存活组。【结论】PCT可以作为判断脑梗死合并肺部感染的的早期指标,而且可以反映病情程度。【Objective】To investigate the diagnostic value of procalcitonin（PCT） levels as an early indicator of pulmonary infection in stroke patients.【Methods】Thirty patients with acute ischemic stroke were admitted in the intensive care unit because of severe brain injury or multiple organ dysfunction.Patients were divided into two groups： pulmonary infection and non-infection,according to their clinical symptoms and laboratory examinations.PCT、CRP and WBC levels were detected at admission,3 and 7 days after admission respectively.Sputum culture and chest X ray were also examined simultaneously.APACHE（Acute Physiology,Age,Chronic Health Evaluation） II score and survival were evaluated over a period of 28 days.【Results】PCT was significantly higher in pulmonary infection group as compared with the noninfection group.The sensitivity（97%）,specificity（91.7%） and positive predictive values（82.1%）of PCT were much higher than those of CRP and WBC.Higher APACHEII score levels were associated with significantly higher PCT plasma concentrations,whereas CRP was elevated irrespective of the scores observed.PCT value of non-survival patients was higher than that of survivors.【Conclusion】 PCT can be used as a predictive marker of infection in stroke patients.It provides more information about the severity and the course of the disease.

关 键 词：脑梗死 降钙素原 肺部感染 

分 类 号：R743[医药卫生—神经病学与精神病学]