降钙素原对社区获得性军团菌肺炎患者临床转归的评估价值  

Value of procalcitonin in evaluation of clinical prognosis of patients with community-acquired Legionella pneumonia

作　　者：杨珍[1] 赵苏[1] 杨炯[2] 王丽慧[2] 

机构地区：[1]武汉市中心医院呼吸内科,湖北武汉430000 [2]武汉大学中南医院呼吸内科,湖北武汉430071

出　　处：《中华医院感染学杂志》2016年第17期3869-3871,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81025008)

摘　　要：目的研究血清降钙素原(PCT)对社区获得性军团菌肺炎(CALP)病情严重程度及临床转归评估价值,以指导临床治疗决策及提高患者生存率。方法回顾性分析2012年1月-2013年5月诊断为CALP的患者41例,将患者分为临床转归良好组27例,临床转归不良组14例;比较两组患者入院时血清PCT水平、C-反应蛋白(CRP)、外周血白细胞计数(WBC),PSI、CURB65及APACHEⅡ评分的差异,观察入院2周血清PCT水平动态变化和患者临床结局的关系,分析血清PCT对CALP临床转归评估的能力。结果临床转归不良组入院时血清PCT水平(7.67±0.68)ng/ml,明显高于转归良好组(0.37±0.05)ng/ml(P<0.01),呼吸喹诺酮类治疗有效的患者多在5d内出现血清PCT下降折点;与CURB-65评分及PSI评分相比,血清PCT水平对CALP临床转归不良的评估有更高的判断价值(AUC值0.960,P=0.026)。入院时血清PCT水平与APACHEⅡ评分、CURB-65评分和PSI评分均呈正相关。结论血清PCT水平可作为CALP病情严重程度及临床转归评估的可靠敏感指标。OBJECTIVE To explore the value of procalcitonin（PCT）in evaluation of severity and clinical prognosis of community-acquired Legionellapneumonia（CALP）so as to provide guidance for clinical treatment and raise the survival rate.METHODS A total of 41 patients who were diagnosed with CALP from Jan 2012 to May 2013 were retrospectively analyzed,then the enrolled patients were divided into the good clinical outcome group with 27 cases and the adverse clinical outcome group with 14 cases.The level of serum PCT,C-reactive protein（CRP）,peripheral blood white blood cell（WBC）counts,PSI,CURB65,and APACHEⅡscore were observed and compared between the two groups of patients at the admission to the hospital,the relationship between the dynamic change of level of serum PCT and the clinical outcomes was observed after the admission for 2weeks,and the value of serum PCT in evaluation of clinical prognosis of CALP was analyzed.RESULTTS The level of serum PCT of the adverse clinical outcome group was（7.67±0.68）ng/ml,significantly higher than（0.37±0.05）ng/ml of the good clinical outcome group（P〈0.01）.The patients who were effective for respiratory quinolones presented with dropped point of serum PCT within 5days.As compared with CURB-65 and PSI,the level of serum PCT had higher predictive value in evaluation of adverse clinical outcome of CALP（AUC value 0.960,P=0.026）.The level of serum PCT at the admission to the hospital was positively correlated with the APACHE Ⅱ score,CURB-65 score,and PSI score.CONCLUSIONThe level of serum PCT can be used as a reliable sensitive indicator for evaluation of severity of CALP as well as clinical outcome.

关 键 词：降钙素原 肺炎 嗜肺军团菌 

分 类 号：R446[医药卫生—诊断学]