降钙素原动态变化对休克型肺炎早期诊断及预后预测的意义  

Value of dynamic change of procalcitonin on early diagnosis and prognosis for pneumonia with shock

作　　者：庄虹[1] 

机构地区：[1]深圳市龙岗中心医院呼吸内科,518116

出　　处：《国际呼吸杂志》2014年第2期87-90,共4页International Journal of Respiration

摘　　要：目的分析血清降钙素原（PCT）动态变化对早期诊断休克型肺炎以及预测预后结局的临床价值。方法选择我院就诊的74例肺炎患者，按严重程度分为2组：研究组34例，罹患休克型肺炎；对照组40例，未罹患休克型肺炎。于治疗的第1、3、5天分别检测并比较两组的血清PCT、IL-1、肿瘤坏死因子α（TNF-α）、超敏C反应蛋白（hs—CRP）及中性粒细胞（Neu）。随访3个月，比较两组的感染相关器官功能衰竭评分（SOFA）以及阳性症状量表II（SAPSII）分值差异，并依据预后结局分为死亡组和生存组，比较两组上述指标的差异。应用多元Logistic回归分析上述指标与SAPSII的相关性。结果对照组PCT、IL-1、TNF-α、hs—CRP及Neu各时间点数值差异无统计学意义（P〉0．05），而研究组各个时间点上述指标均较对照组明显升高（P〈0．05）。研究组的PCT峰值时间较IL-1、TNF-a、hs—CRP及Neu提前（P〈0．05）。随访3个月后，研究组的SOFA以及SAPSⅡ分值显著高于对照组（t=4．023，P=0．001；t=5．243，P=0．001）。与死亡组相比，生存组PCT、IL-1、TNF-α以及hs—CRP较低（t值分别为3．892、3．624、3．268、2．987，P值均〈0．05），而Neu无差异（t=2．012，P=0．086）。血清PCT浓度与SAPSII评分呈正相关（OR=0．591，95％CI：0．309～0．825，P=0．013）。结论血清PCT动态变化能早期诊断休克型肺炎，对预后结局判断有较高价值。Objective To analyze the early diagnostic and prognostic value of the dynamic change of procalcitonin （PCT） on patients with pneumonia with shock. Methods 74 patients with pneumonia were collected and divided into two groups：research group （34 cases,diagnosed as pneumonia with shock） and control group （40 cases,diagnosed as normal pneumonia） according to severity of pneumonia. The values of PCT, IL-1, tumor necrosis faetor-α （TNF-α）, high secsitivity C-reactive protein （hs-CRP） and neutrophil （Neu） were detected and compared between two groups on 1st, 3rd, 5th day, respectively. After follow-up for three months, the values of sepsis-related organ failure assessment （SOFA） and scale for the assessment of positive symptoms II （SAPS II ） were compared between two groups. And all patients were divided into two groups：death group and survival group according to prognostic outcomes. And the above indexes were also compared between two groups. The relationship of the above indexes with SAPS I was analyzed by multivariate Logistic regression analysis. Results The values of PCT, IL-1, TNF-α, hs-CRP,and Neu in control group were no different among above three time-points （ P 〈0.05）. And the values of above indexes in research group were higher than those in control group at each time-point （ P 〈0.05）. The climax time of PCT was earlier than that of IL-1, TNF-α, hs-CRP,and Neu （ P 〈0.05）. After follow-up for three months, the values of SOFA and SAPSII in research group were higher than those in control group （ t =4. 023, P ：0. 001; t = 5. 243, P =0. 001）. Compared to death group, the values of PCT, IL-1, TNF-α,and hs-CRP in survival group were obviously lower （ t =3. 892,3. 624,3. 268,2. 987, respectively, all P 〈0.05）, but the value of Neu was no different between two groups （ t = 2. 012, P = 0. 086）. The serum concentration of PCT had positive relationship with SAPS II score （ OR =0. 591,95% CI ：0. 309-0. 825, P =0. 013）. Conclusions The dyna

关 键 词：降钙素原 休克型肺炎 临床诊断 预后 

分 类 号：R563.1[医药卫生—呼吸系统]