降钙素原检测对肺结核合并肺部细菌感染诊断的临床价值研究  

The study of procalcitonin clinical value in 134cases of pulmonary tuberculosis patients complicated with other bacterial infection

作　　者：卢家泽[1] 邝浩斌[1] 李德宪[1] 梁国添[1] 

机构地区：[1]广州市胸科医院重症结核科,510095

出　　处：《中国防痨杂志》2013年第11期923-926,共4页Chinese Journal of Antituberculosis

摘　　要：目的 探讨降钙素原检测在肺结核合并肺部细菌感染诊断中的临床价值。 方法 选取2012年5—9月广州市胸科医院重症结核科收治的临床确诊为肺结核的患者134例。根据患者急性生理和慢性健康状况（acute physiology and chronic health evaluation，APACHE-Ⅱ）评分分为重症组（51例，入住重症监护室，APACHE-Ⅱ评分为19～34分，平均23.71分）和轻症组（83例，入住普通病房的肺结核患者）；根据患者是否合并肺部细菌感染分为肺结核合并肺部感染组（61例） 和单纯肺结核组（73例）。测定患者血清降钙素原（PCT）水平。使用 SPSS 17.0 统计软件进行统计分析。计量资料以中位数和上下四分位数（P25，P75）表示，组间计量数值的比较应用秩和检验的Mann-Whitney U检验，以P〈0.01为差异有统计学意义。 结果 重症组患者PCT值的中位数为2.75 μg/L，P25、P75为0.52 μg/L、10.45 μg/L；轻症组患者PCT值的中位数为0.11 μg/L，P25、P75为0.05 μg/L、0.43 μg/L，差异具有统计学意义 （Mann-Whitney，U=690，P=0）。合并肺部细菌感染者的PCT值中位数为3.13 μg/L，P25、P75为1.08 μg/L、10.21 μg/L；单纯肺结核患者PCT值的中位数为0.07 μg/L，P25、P75为0.05 μg/L、0.23 μg/L，差异具有统计学意义 （Mann-Whitney，U=265，P=0）。90.4%（66/73）的单纯肺结核患者的PCT浓度在〈0.5 μg/L范围内。以PCT浓度≥0.675 μg/L作为判定肺结核合并肺部细菌感染的临床临界参考值，其敏感度、特异度分别为85.2%（52/61）、96.3%（52/54）。 结论 测定PCT有助于鉴别肺结核患者是否合并肺部细菌感染和预估疾病严重程度，指导抗生素的使用。Service Objective To explore the clinical value of procalcitonin detection in pulmonary tuberculosis patients complicated with other bacterial infection. Methods Selected 134 cases of pulmonary tuberculosis patients in the Severe Tuberculosis Department in Guangzhou Chest Hospital from May to September in 2012. Based on their APACHE-Ⅱand acute physiology and chronic health evaluation, they were divided into severe group （51 cases, admitted to the intensive care room, APACHE-Ⅱ score of 19 to 34, with an average of 23.71 points） and mild group （83 cases, admitted into the general ward）. Based on the infection situation among these patients, which were divi-ded into pulmonary tuberculosis complicated with pulmonary infection group （61 cases） and pulmonary tuberculosis only group （73 cases）. Detected the concentration of procalcitonin （PCT） in their serum. Results Severe patients median value of PCT was 2.75 μg/L,P25=0.52 μg/L, P75=10.45 μg/L,and that in mild group was 0.11 μg/L,P25=0.05 μg/L,P75=0.43 μg/L, of which was significant difference （Mann-Whitney, U=690,P=0）. The median value of PCT of patients combined with lung infection was 3.13 μg/L,P25=1.08 μg/L,P75=10.21 μg/L, and that in pulmonary tuberculosis only patients was median 0.07 μg/L,P25=0.05 μg/L, P75=0.23 μg/L, of which was statistically significant difference （Mann-Whitney, U=265,P=0）. The PCT concentration of 90.4%（66/73） pulmonary tuberculosis patients was within the range of 〈0.5 μg/L.Their sensitivity and specificity were 85.2%（52/61）,and 96.3%（52/54） respectively,based on an amount of more than 0.675 μg per liter as a critical clinical reference of a patient to be diagnosed with pulmonary infection of pulmonary tuberculosis. Conclusion The mea-surement of procalcitonin was benefit for identifying pulmonary tuberculosis patient complicated with lung infection and prognosis, thus guiding the use of antibiotics.

关 键 词：结核  肺 并发症 肺炎 细菌性 降钙素 蛋白质前体 

分 类 号：R521[医药卫生—内科学]