血清降钙素原质量浓度诊治急性发热患者的临床价值  

The clinical value of serum procalcitonin in diagnosis and treatment for the patients with acute fever

作　　者：徐志锋[1] 李春盛[2] 王力军[3] 陈荣健[1] 李志全[1] 李国明[1] 

机构地区：[1]江门市中心医院急诊科,广东省江门529000 [2]首都医科大学附属北京朝阳医院急诊科 [3]天津医科大学总医院急诊科

出　　处：《中华急诊医学杂志》2013年第8期897-901,共5页Chinese Journal of Emergency Medicine

基　　金：江门市科技局2013年科研立项项目（2013062）

摘　　要：目的探讨血清降钙素原（procalcitonin，PCT）水平在诊治急性发热患者中的临床价值。方法选取2011年9月至2012年5月，广东省江门市中心医院急诊科诊治的急性发热患者285例，随机（随机数字法）分为2组：常规组122例和PCT组163例。均测定血常规、C-反应蛋白，并通过病原学或血清免疫学检查明确诊断；PCT组患者加测PCT。常规组按照抗生素指南进行治疗，PCT组根据PCT质量浓度指导抗生素治疗。比较2组的抗生素费用及疗程、使用率及临床有效率和病死率。PCT组按感染的判定标准分为3个亚组：细菌感染组、病毒感染组和非感染组。采用成组t检验、χ^2检验、单因素方差分析，最小显著法等统计方法，比较各组炎症指标对诊断细菌感染的价值。PCT组按照预后不同，分为预后良好组和预后不良两组，比较两组间血清PCT质量浓度，评价其与细菌感染患者预后的关系。结果常规组和PCT组抗生素的费用及使用率、疗程分别是（3586．5±703．3）元、95．08％、（15．01±11．21）d和（1871．2±433．5）元、54．60％、（11．22±7．10）d，差异具有统计学意义（P〈0．01）；临床有效率、病死率差异无统计学意义（P〉0．05）。血清PCT质量浓度在细菌感染组（1．12±0．88）ng／ml均高于病毒感染组（0．21±0．11）ng／ml和非感染组（0．18±0．13）ng／ml，差异具有统计学意义（P〈0．01）；而后2组的PCT值差异无统计学意义（P〉0．05）。PCT诊断细菌感染的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）均优于其他炎症指标。结论血清PCT质量浓度对急诊医师鉴别诊断急性发热的性质、预后优于其他炎症指标，对临床合理使用抗生素有重要指导意义。Objective To investigate the clinical value of serum procalcitonin （PCT） in the diagnosis and treatment of the patients with high fever of acute illness. Methods A total of 285 febrile patients suffered from acute illness were divided into the conventional group （ n = 122） and the PCT group （n = 163 ）. The routine blood examination and serum level of C-reactive protein （CRP） detection were carried out for the dignosis of these febrile patiens of two groups, and in addition, serum PCT determination was carried out in the patients of PCT group. The diagnosis was cornnfirmed by etiology or immunologic assays. Routine guidelines of administrating antibiotics were used for treatment in the conventional group. Whereas the antibiotic therapy given to patients of PCT group was guided by the serum PCT levels. Two groups were compared in respect of the antibiotics costs, duration of treatment with antibiotics, percentage of patients treated with antibiotics, efficiency of antibiotics treatment and the mortality rate. The patients of PCT group were further divided as per inflammatory markers of bacterial infection into three subgroups, namely bacterial infection group, viral infection group and non-infection group. At last, the relationship between serum PCT level and the prognosis of patients was analyzed. Results The cost of antibiotics, percentage of patients treated with antibiotics, and course of antibiotics treatment were ￥（ 3586. 5 ± 703.3 ）, 95.08% and （ 15.01 ± 11.21 ） days, respectively in conventional group, whereas ￥ （ 1871.2 ± 433.5）, 54. 60% , （11. 22 ±7. 10） days in PCT group with statistically significant difference between two groups （ P 〈 0. 01 ） , but there were no significant differences in clinical efficiency and mortality between groups （P 〉0. 05）. Serum PCT （ 1. 12 ±0. 88） ng/ml in bacterial infection group was higher than that in both virus infected group （0. 21 ± 0. 11 ） ng/ml and non -infected group （0. 18 ± 0. 13 ） ng/ml. There wa

关 键 词：急性发热 血清降钙素原 感染 

分 类 号：R459.7[医药卫生—急诊医学]