动态监测C-反应蛋白评估重症社区获得性肺炎疗效和预后的临床研究  

The clinical research of dynamic monitoring C- reactive protein used to access the curative effect and prognosis of severe community- acquired pneumonia

作　　者：王旭亮[1] 孙国磊[2] 高书健 徐磊[3] 

机构地区：[1]天津医科大学第三中心临床学院,天津300170 [2]天津市津南区咸水沽医院重症医学科,天津300350 [3]天津市第三中心医院重症医学科,天津300170

出　　处：《吉林医学》2015年第1期36-38,共3页Jilin Medical Journal

摘　　要：目的:探讨动态监测C-反应蛋白(CRP,C-reactive protein)用于评估重症社区获得性肺炎疗效和预后的价值。方法:60例均为≥18岁的重症社区获得性肺炎患者,入住ICU的当天定义为D0,随后的每天定义为D1、D2、……D7。每天监测血CRP、降钙素原(PCT)、白细胞(WBC),计算SOFA评分。计算D1、D2、……D7的CRP值与D0的CRP值之比,定义为C-反应蛋白比率(CRP-ratio),计算每日的C-反应蛋白值与前一天的C-反应蛋白值的变化值,称之为△CRP,用△CRP除以前一天的C-反应蛋白值,定义为C-反应蛋白变化率(CRP-rate)。依据出院时结局,将患者分为存活组和死亡组,统计上述指标变化,在各组中对比分析,得出结论。结果:D3的CRP-ratio>0.55是疗效不佳,预后较差的一个标志(敏感性0.82;特异性0.54),与此点的PCT及SOFA评分相比具有更高的敏感性;CRP-rate≥0.25是治疗有效,预后良好的标志(敏感性0.81;特异性0.82)。结论:早期动态监测血CRP-rate能够评估重症社区获得性肺炎疗效和预后,计算CRP-ratio可以早在抗感染治疗后的第三天评估治疗效果和预后,较PCT及SOFA评分具有更高的敏感性。Objective To explore the value of dynamic monitoring C -reactive protein （CRP,C -reactive protein） that was used to assess the curative effect and prognosis of severe community - acquired pneumonia. Method 60 cases were more than 18 year old patients with severe community acquired pneumonia. The day of ICU admission was defined as DO ,and the following days were successively defined as DI, D2,…, D7. Blood CRP value,procalcitonin（PCT） and white blood cells （WBC） were daily monitored,and sequence of organ failure score （ SOFA ） was daily calculated in each person. Calculation of D1, D2,-.., D7 CRP value divided by DO CRP value was defined as C - reactive protein ratio （CRP- ratio）. The changes between the value of C -reactive protein of the daily and the day before were calculated, and were called △ CRP. Calculation of △ CRP divided by C -reactive protein values of the day before ,was defined as C -reactive protein rate （ CRP - rate）. Basis in discharge end the patients were divided into survival group and death group,and the changes of above indexes were analyzed by statistics in each group,and the conclusion was obtained. Results CRP -ratio of D3 〉 0. 55 was a sign of poor curative effect and prognosis （sensitivity 0. 82; specificity 0. 82）, which had higher sensitivity than PCT and SOFA score of D3. CRP - rate 〉10. 25 was the mark of a effective treatment and a good prognosis （ sensitivity 0. 81 ;specificity 0.82）. Conclusion Early dynamic monitoring of blood CRP- rate could be used to evaluate the curative effect and prognosis of severe community - acquired pneumonia, To calculate CRP - ratio could be as early in the third day after anti - infection treatment used to evaluate the treatment effect and prognosis, which had higher sensibility than the PCT and SOFA score.

关 键 词：C反应蛋白 重症社区获得性肺炎 价值 

分 类 号：R563.1[医药卫生—呼吸系统]