老年感染性疾病患者降钙素原白细胞及血清C-反应蛋白检测的临床意义  

The clinical application of procalcitonin, leukocyte count and C-reactive protein in elderly patients with infection

作　　者：吴培[1] 单纯[1] 张群[1] 许银芳[1] 秦燕萍[1] 高超[1] 苏瑞霞[1] 

机构地区：[1]东南大学附属中大医院感染科,南京210009

出　　处：《中华老年医学杂志》2012年第10期833-836,共4页Chinese Journal of Geriatrics

基　　金：江苏省自然科学基金重点项目（BK2010088）

摘　　要：目的比较降钙素原、白细胞、中性粒细胞（N）及血清c一反应蛋白（CRP）检测在老年人感染性疾病中临床应用的价值。方法采用我院电子病历、挂号和处方系统（HIS系统）收集年龄≥65岁、发热（腋温）〉38．0℃、有感染或疑似有感染征象，进行了降钙素原、白细胞及CRP检测及细菌学检查的相关病例，结合病史进行回顾性分析。并将治疗后的降钙素原、白细胞和CRP检测结果与治疗前进行比较。结果入选患者219例，其中对照组65例，全身炎症反应综合征（SIRS）组48例，脓毒症组106例，脓毒症组中血白细胞计数正常组51例，异常组55例。脓毒症组病死率为11．4％（25／106），与SIRS组1．8％（4／48）及对照组0．900（2／65）比较，差异有统计学意义（χ2=15．660，P=0．000）。血清降钙素原浓度与患者的感染程度呈正相关，Spearman相关系数为0．706（95％CI：0．616～0．797，p=0．000）。以降钙素原、白细胞、CRP指标进行ROC曲线分析，降钙素原判断最佳诊断界值为〉O．341μg／L（灵敏度为84．5％，特异度为55．8%）；降钙素原比值对感染控制的曲线下面积（A）为0．916（95％CI：0．864～0．967，P=0．000），其判断感染的阈值为0．73μLg／L（灵敏度为84．6％，特异度为88．0%）。结论对老年感染性疾病患者进行降钙素原检测，能很好地反映出病情的变化，是特异性较高的炎症指标；降钙素原的变化可以指导临床抗生素的使用，从而避免滥用抗生素，减少细菌耐药性的产生。Objective To analyze and compare the clinical application values of procalcitonin （PCT）, leukocyte count（WBC） and C-reactive protein（CRP） in elder patients with infection. Methods In patients （age ≥ 65 yrs, axillary temperature〉 38.0℃）with infection or suspected infection, PCT, WBC, CRP and other bacteriological examination were performed. The electronic medical records from the HIS system of our hospital were analyzed retrospectively in combination with medical history. Results Of the enrolled 219 patients, 65 ones were in control group, 48 ones SIRS, 51 ones sepsis and 55 ones MODS. There was a positive correlation between the level of serum PCT and the infection degree. The Spearman correlation coefficient was 0. 706 （95 % CI：0. 616-0. 797, P=0. 000）. Based on the highest Youden index （sensitivity＋ specificity-I）, the best cutoff point of diagnosis for PCT was 〉0. 341 gg/L （sensitivity 84.5%, specificity 55.8%）, a analysis of receiver operating characteristic（ROC） curve about PCT, WBC and CRP was carried. Area under the curve （AUC） of PCT to controlled infection was 0. 916 （95%CI： 0. 864-0. 967, P=0. 000）. Based on the highest Youden index （sensitivity＋ specificity-l）, the judging threshold of PCT to infection controlled or not was 0.73 /lg/L （sensitivity 84.6%, specificity 88.0%）. PCT level after treatment 〉0.73 μg/L showed the uncontrolled infection, 〈 0.73μg/L controlled. Conclusions PCT has a higher specificity for elder patients with infection. The variation of PCT level can guide the application of antibiotics, avoid abuse and decrease the occurrence of drug-resistant bacteria.

关 键 词：降钙素原 白细胞计数 C反应蛋白质 感染 

分 类 号：R446.6[医药卫生—诊断学]