血清降钙素原对慢性心力衰竭急性发作患者的临床评估价值  

Value of clinical evaluation of serum procalcitonin in patients with acute attack of chronic heart failure

作　　者：司志燕[1] 宋文奇[2] 冯晓红[3] 王丹[4] 林丽萍[1] SI Zhi-yan;SONG Wen-qi;FENG Xiao-hong;WANG Dan;LIN Li-ping(Department of Healthcare-associated Infection Management,Handan Central Hospital,Handan 056001,China;Department of Cardiovascular Medicine,Handan Central Hospital,Handan 056001,China;Department of Human Resource,Handan Central Hospital,Handan 056001,China;Department of Blood Purification,Handan Central Hospital,Handan 056001,China)

机构地区：[1]邯郸市中心医院医院感染管理科,河北邯郸056001 [2]邯郸市中心医院心血管内科,河北邯郸056001 [3]邯郸市中心医院人事科,河北邯郸056001 [4]邯郸市中心医院血液净化科,河北邯郸056001

出　　处：《中国感染控制杂志》2019年第1期42-46,共5页Chinese Journal of Infection Control

摘　　要：目的评估血清降钙素原(PCT)升高与尚无明确细菌感染证据的慢性心力衰竭急性发作患者临床基础特征及预后的关系。方法对2015年2月—2017年12月于邯郸市中心医院住院的慢性心力衰竭急性发作患者进行前瞻性研究。根据PCT水平分为PCT升高组及PCT正常组,对比两组患者入院后的临床基础特征,应用logistic回归分析PCT升高的原因;比较入院后规范治疗48 h后的效果、30 d内全因死亡/再住院发生率。结果共纳入593例慢性心力衰竭急性发作患者,其中PCT正常组521例,PCT升高组72例。logistic回归分析表明,心率增快、肺水肿、白细胞计数、血尿素氮(BUN)与PCT升高呈正相关,白细胞计数相关性最大[OR=2. 19(95%CI:1. 76～2. 73),P <0. 001];而血红蛋白及血清蛋白与PCT的升高呈负相关。标准化治疗48 h后,PCT正常组有67. 9%的患者症状明显改善,高于PCT升高组的55. 6%,差异有统计学意义(P=0. 037)。PCT升高组患者30 d全因死亡/再住院率(30. 6%)高于PCT正常组(18. 8%),差异有统计学意义(P=0. 02)。结论尽管心力衰竭程度一致,但血清PCT水平升高的慢性心力衰竭急性发作患者治疗效果差、预后不佳,提示可能存在未诊断或者潜在的细菌感染。Objective To evaluate the relationship between serum procalcitonin (PCT) elevation and clinical characteristics and prognosis of patients with acute attack of chronic heart failure(CHF) but without clear evidence of bacterial infection.Methods Patients with acute attack of CHF and hospitalized in Handan Central Hospital from February 2015 to December 2017 were studied prospectively.According to PCT level,patients were divided into elevated PCT group and normal PCT group,basic clinical characteristics of two groups of patients were compared,causes of PCT elevation were analyzed by logistic regression;efficacy of standard treatment 48 hours after admission and the incidence of all-cause death/readmission within 30 days were compared.Results A total of 593 patients with acute attack of CHF were enrolled,including 521 patients with normal PCT and 72 patients with elevated PCT.Logistic regression analysis showed that the increase of heart rate,pulmonary edema,white blood cell count(WBC) and blood urea nitrogen (BUN) were positively correlated with the elevation of PCT,especially WBC ( OR ,2.19 [95% CI ,1.76-2.73],P < 0.001 );hemoglobin and serum albumin were negatively correlated with PCT elevation.After 48 hours of standardized treatment,symptoms of 67.9% of patients in normal PCT group significantly improved,which was higher than 55.6% in elevated PCT group ( P=0.037).The 30-day all-cause mortality/readmission rate in patients in elevated PCT group was higher than that in normal PCT group (30.6% VS 18.8%),difference was statistically significant ( P =0.02).Conclusion Although the degree of heart failure is the same,patients with acute attack of CHF and elevated serum PCT level have poor therapeutic effect and poor prognosis,suggesting that there may be undiagnosis or potential bacterial infection.

关 键 词：降钙素原 慢性心力衰竭急性发作 细菌感染 预后 

分 类 号：R541.6[医药卫生—心血管疾病]