重症肺炎患者PCT、CRP、APACHEⅡ评分与病原菌及预后的关系  

Correlation between PCT, CRP, APACHEⅡ score, pathogenic bacteria and prognosis in patients with severe pneumonia

作　　者：唐玮欣 余雪涛[1] 陈兰春[1] 丘自挺[1] 李展汉 TANG Wei-xin;YU Xue-tao;CHEN Lan-chun(Department of Critical Medicine,Longgang District People’s Hospital,Shenzhen 518172,China)

机构地区：[1]深圳市龙岗区人民医院重症医学科

出　　处：《中国实用医药》2020年第1期20-22,共3页China Practical Medicine

基　　金：深圳市龙岗区科技计划资助项目(项目编号：YLWS20150514114457328)

摘　　要：目的探讨不同病原菌感染的重症肺炎患者降钙素原(PCT)、C反应蛋白(CRP)、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分的差异,以及其与预后的关系。方法49例重症肺炎且痰培养阳性患者,按照痰培养结果分为革兰阴性菌组(21例)及革兰阳性菌组(28例)。观察患者病原菌分布情况,比较革兰阴性菌组、革兰阳性菌组患者PCT、CRP、APACHEⅡ评分;比较两组不同病情转归患者PCT、CRP、APACHEⅡ评分。结果49例重症肺炎患者中,革兰阳性菌占57.14%(28/49),以金黄色葡萄球菌为主;革兰阴性菌阳性占42.86%(21/49),以肺炎克雷伯杆菌、嗜麦芽窄食单胞菌、铜绿假单胞菌为主。革兰阴性菌组患者PCT(105.23±70.91)mg/L、CRP(6.93±12.99)ng/L及APACHEⅡ评分(17.68±5.24)分均高于革兰阳性菌组的(58.76±79.21)mg/L、(0.62±0.81)ng/L、(14.25±5.87)分,差异有统计学意义(P<0.05)。革兰阳性菌组、革兰阴性菌组死亡患者的PCT、CRP及APACHEⅡ评分均高于好转患者,差异有统计学意义(P<0.05)。结论PCT、CRP及APACHEⅡ评分有助于区分革兰阴性菌感染与革兰阳性菌感染;PCT、CRP及APACHEⅡ评分对重症肺炎预后的判定有重要的临床价值。Objective To discuss the difference of procalcitonin(PCT),C-reactive protein(CRP),acute physiological and chronic health evaluationⅡ(APACHEⅡ)score in patients with severe pneumonia infected by different pathogens,and their correlation to prognosis.Methods A total of 49 patients with severe pneumonia were divided into gram-negative bacteria group(21 cases)and gram-positive bacteria group(28 cases)according to the results of sputum culture.The distribution of pathogenic bacteria was observed,and PCT,CRP and APACHEⅡscore were compared between gram-negative group and gram-positive group.The PCT,CRP,APACHEⅡscores were compared between the two groups with different outcomes.Results In 49 patients with severe pneumonia,gram-positive bacteria accounted for 57.14%(28/49),mainly Staphylococcus aureus;gramnegative bacteria accounted for 42.86%(21/49),mainly Klebsiella pneumoniae,Stenotrophomonas maltophilia and Pseudomonas aeruginosa.PCT(105.23±70.91)mg/L,CRP(6.93±12.99)ng/L and APACHEⅡscore(17.68±5.24)points in gram-negative group was higher than(58.76±79.21)mg/L,(0.62±0.81)ng/L and(14.25±5.87)points in gram-positive group.Their difference was statistically significant(P<0.05).The PCT,CRP and APACHEⅡscore of the dead patients in the gram-positive bacteria group and the gram-negative bacteria group were higher than those of the improved patients,their difference was statistically significant(P<0.05).Conclusion PCT,CRP and APACHEⅡscore are helpful to distinguish gram-negative bacterial infection from gram-positive bacterial infection,and PCT,CRP and APACHEⅡscores have important clinical value in the prognosis of severe pneumonia.

关 键 词：重症肺炎 预后 C反应蛋白 降钙素原 急性生理与慢性健康状况Ⅱ评分 

分 类 号：R563.1[医药卫生—呼吸系统]