血清降钙素原在社区获得性细菌性肺炎的检测时机分析  

The timing of procalcitonin detection in patients with community-acquired bacterial pneumonia

作　　者：谢丹[1] 冼盈[1] 毕筱刚[1] 王颖[1] 尤婧雅 张扣兴[1] 

机构地区：[1]中山大学附属第三医院岭南医院综合ICU,广州510530

出　　处：《新医学》2016年第1期52-55,共4页Journal of New Medicine

摘　　要：目的分析社区获得性细菌性肺炎（CABP）患者血清降钙素原与SIRS之间的关系,探讨CABP患者血清降钙素原的检测时机。方法收集139例CABP住院患者,根据有无SIRS症状分为SIRS组（60例）和无SIRS组（79例）,比较2组患者的血清降钙素原、CRP、ESR、白细胞计数、中性粒细胞比例的差异。同时绘制各指标对CABP患者发生SIRS的受试者工作特征（ROC）曲线,并确定血清降钙素原及CRP诊断CABP患者发生SIRS的最佳截断值。结果 SIRS组CABP患者的血清降钙素原、CRP、ESR、白细胞计数、中性粒细胞比例均高于无SIRS组（P均〈0.05）。在各指标中,血清降钙素原诊断SIRS的ROC曲线下面积最大（0.902,95%CI 0.853-0.952,P〈0.001）。血清降钙素原诊断CABP患者发生SIRS的最佳截断值为0.068μg/L,接近其正常参考值0.05μg/L,其敏感度为90%、特异度为80%、阳性预测值77%、阴性预测值91%。结论在CABP患者中,血清降钙素原较其他传统炎症指标能更好地反映SIRS。对CABP患者,应在出现SIRS症状时进行血清降钙素原检测,无SIRS症状时不建议常规检测血清降钙素原。Objective To analyze the relationship between procalcitonin （PCT） and systemic inflammatory response syndrome （SIRS） in patients with community-acquired bacterial pneumonia （CABP）, and investigate the proper timing of PCT detection in CABP patients. Methods One hundred and thirty nine hospitalized CABP patients were recruited and divided into the SIRS groups （ n = 60） and non-SIRS groups （ n = 79 ） based on the presence of SIRS. The levels of PCT, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, white blood cell count and neutrophil ratio were measured and statistically compared between two groups. Receiver operating characteristic （ROC） curves of all indicators were described in CABP patients presenting with SIRS, and the optimal cut-off values of PCT and CRP in diagnosing SIRS in CABP patients were e- valuated. Results The levels of PCT, CRP, ESR, white blood cell count and neutrophil ratio in the SIRS group were significantly higher than those in the non-SIRS group （ all P 〈 0. 05 ） . The area under curves （AUCs） of PCT in predicting SIRS was the largest （0. 902, 95% CI 0. 853-0. 952, P 〈0. 001 ）. The optimal cut-off value of PCT in diagnosing SIRS in CABP patients was 0. 068 μg/L, almost close to the normal reference value of 0.05 μg/L, presenting with a sensitivity of 90% , specificity of 80% , positive predictive value of 77% and negative predictive value of 91%. Conclusions In CABP patients, PCT level can better predict SIRS in CABP patients compared with conventional inflammatory markers. Detection of PCT level should be performed at the presence of SIRS-related symptoms, which is not recommended without SIRS-induced manifestations.

关 键 词：社区获得性细菌性肺炎 降钙素原 全身炎症反应综合征 C-反应蛋白 

分 类 号：R563.1[医药卫生—呼吸系统]