降钙素原在社区获得性肺炎中的临床意义  

The role of serum procalcitonin in evaluating the severity and prognosis in patients with community acquired pneumonia

作　　者：吴春荣[1] 崔宇慧[1] 杨春辉[1] 唐建国[1] 

机构地区：[1]复旦大学附属上海市第五人民医院创伤急救危重症医学中心,上海200240

出　　处：《中华急诊医学杂志》2014年第12期1376-1380,共5页Chinese Journal of Emergency Medicine

摘　　要：目的分析社区获得性肺炎（community acquired pneumonia，CAP）患者血清降钙素原（procalcitionin，PCT）质量浓度（ng／mL）及变化规律，评估其在CAP治疗疗效、严重程度及预后中的作用。方法回顾2011年11月15日至2012年11月15日上海市第五人民医院重症监护室（general intensive care unit，GICU）收治的50例CAP患者病史资料及实验室检查结果，排除合并其他部位感染、手术及外伤患者，统计治疗前和治疗过程中的PCT质量浓度，并分析呼吸衰竭、机械通气、治疗结果三者与PCT的关系。结果根据是否发生脓毒症分为脓毒症组和非脓毒组，非脓毒症组GICU治疗前PCT质量浓度，治疗过程中的最高PCT质量浓度，治疗期间平均PCT质量浓度分别为0．1125（0．078，0．269）、0．1235（0．078，0．494）、0．1355（0．08，0．245），脓毒症组则分别8．92（2．715，16．33）、13．53（6．305，25．625）、4．26（2．1415，8．2455），两组间三项指标差异均有统计学意义（相对应的Zlst=-4．743，Plst〈0．05；Zmax=-5．783，PM。〈Q05；Zmean=-5．644，Pmean〈0．05）；按照治疗过程中是否发生呼吸衰竭对患者进行分组，呼吸衰竭组平均PCT质量浓度为1．7375（0．224，5．092），未发生呼吸衰竭组为0．081（0．049，0．146），两组间差异具有统计学意义（Z=4．472，P〈0．05）；根据治疗过程中机械通气情况分组，机械通气组患者平均PCT质量浓度为1．618ng／mL（0．224，5．092），未使用机械通气组为0．086ng／mL（0．061，0．465），两组间差异具有统计学意义（z=-3．788，P〈0．05）；根据治疗结果分组，死亡组平均PCT质量浓度为7．4585ng／mL（2．392，16．25），存活组为0．1965ng／mL（0．885，0．618），组间差异具有统计学意义（z=3．857，P〈0．05）。利用两组患者入监护室24h内的PCT值绘制受试者工作曲线（receiver operating charaObjective To analyze the value of serum procalcitonin （PCT） in patients with community acquired pneumonia （CAP）, and to evaluate the role of PCT in the therapeutic effect, severity and prognosis. Methods A retrospective analysis of data and laboratory tests of 50 patients with CAP admitted from November 15, 2011 to November 15, 2012 in GICU was carried out. Patients with infection of other parts of body, surgical treatment and trauma were ruled out. The level of PCT （ng/mL） before and during treatment, and the relationships between PCT and respiratory failure, mechanical ventilation, treatment results were analyzed respectively. Results According to the occurrence of sepsis, 50 patier were divided into sepsis group and non-sepsis group. In the non-sepsis group, the PCT level befc treatment, the highest and average PCT levels during the treatment were 0. 1125 （0. 078, 0. 269）, 0. 1235（0. 078, 0. 494）, and 0. 1355 （0. 08, 0. 245 ） respectively. Correspondingly, the PCT levels in the sep, group were 8.92 （2. 715, 16. 33）, 13.53 （6. 305, 25. 625）, and 4. 26 （2. 1415, 8. 2455）, and the were statistically significant differences in three values of PCT between groups （ Zlst = - 4. 743, PlST 0. 05 ; Zmat= -5. 783, PMat 〈 0.05 ; Zmean = - 5. 644, PMean 〈 0.05 ）. According to the emergence respiratory failure during treatment, average PCT level in the patients with respiratory failure was 1.73＂ （0. 224, 5. 092）, and that in the patients without respiratory failure was 0. 081 ng/mL （0. 049, 0. 1461 presenting the statistically significant difference between two groups （ Z = 4. 472, P 〈 0. 05 ）. In ease using mechanical ventilation （ MV）, the average PCT level of the patients with mechanical ventilation w 1. 618 ng/mL （0. 224, 5. 092）, and that in the patients without MV was 0. 086 ng/mL （0. 061, 0. 4651 producing a significant difference between the two groups （ Z = - 3. 788, P 〈 0.05 ）. Grouped according the outcome of patients, the mean value of PCT

关 键 词：社区获得性肺炎 降钙素原 脓毒症 预后 呼吸衰竭 机械通气 感染 重症监护室 

分 类 号：R563.1[医药卫生—呼吸系统]