血清降钙素原联合临床肺部感染评分在呼吸机相关性肺炎诊断中的应用  

Application of PCT combined with CPIS in diagnosis of patients with VAP

作　　者：王宇[1] 左霞[1] 

机构地区：[1]辽宁省鞍山市中心医院特诊一病房,辽宁鞍山114001

出　　处：《实用临床医药杂志》2015年第11期23-25,共3页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11521143)

摘　　要：目的探讨血清降钙素原(PCT)及临床肺部感染评分(CPIS)在呼吸机相关性肺炎(VAP)诊断中的应用。方法选取ICU收治的需要行有创机械通气患者59例,将7 d内发生VAP的35例患者设为VAP组,未发生VAP的24例患者设为非VAP组。于机械通气前检测相关炎症反应标志物血清PCT、C反应蛋白(CRP)及血常规,并进行CPIS评分。VAP组于VAP发生后检测上述指标,而非VAP组于机械通气7 d时检测上述相关指标。结果行机械通气后,VAP组患者PCT、CRP水平升高(P<0.01),非VAP组患者PCT、CRP、白细胞计数(WBC)变化差异无统计学意义(P>0.05);VAP组PCT、CRP水平显著高于非VAP组(P<0.01);PCT诊断VAP的ROC曲线下面积为0.876,诊断价值较高,以PCT≥0.4μg/L为阳性阀值,诊断敏感性为91.4%(32/35),特异性为70.8%(17/24),进一步联合CPIS诊断,特异性可达100%(24/24);PCT和CPIS呈显著相关(P=0.002),CRP与CPIS无明显相关性(P=0.286)。结论 PCT用于诊断VAP具有较高的敏感度和特异度,联合CPIS评分可提高诊断特异度。Objective To explore the application of procalcitonin（ PCT） and clinical pulmonary infection score（ CPIS） in the diagnosis of patients with ventilator-associated pneumonia（ VAP）.Methods A total of 59 patients required invasive mechanical ventilation（ IMV） in intensive care union（ ICU） were selected,in which 35 cases with VAP within 7 days were designed as VAP group,while another 24 cases without VAP were designed as non-VAP group. Relevant inflammatory markers such as serum PCT and C-reactive protein（ CRP） as well as blood routine were detected before IMV and CPIS scoring was conducted. The above indexes were detected immediately after VAP in VAP group and 7 days after IMV in non-VAP group. Results After IMV,levels of PCT and CRP increased evidently in VAP group（ P〈0. 01）,but there were no significant differences in PCT,CRP and white blood cell count（ WBC） in non- VAP group（ P〈0. 05）, and the levels of PCT and VAP were significantly higher in VAP group than in non- VAP group（ P〈0. 01）. The area under ROC curve of VAP diagnosed by PCT was 0. 876,and the diagnostic value was high. With PCT≥0. 4 μg / L as the positive threshold value,the diagnostic sensitivity and specificity were 91. 4%（ 32 /35） and 70. 8%（ 17 /24） respectively,and further diagnosis combing with CPIS showed that the specificity was up to 100%（ 24 /24）. Additionally, PCT was associated with CPIS（ P = 0. 0 0 2）,but there was no obvious correlation between CRP and CPIS（ P =0. 286）. Conclusion PCT has high sensitivity and specificity in the diagnosis of VAP,and combining with CPIS score can increase the diagnostic specificity.

关 键 词：呼吸机相关性肺炎 血清降钙素原 临床肺部感染评分 C反应蛋白 

分 类 号：R563.1[医药卫生—呼吸系统]