PCT和CRP在重症颅脑外伤合并呼吸机相关性肺炎中的诊断价值  

Diagnostic value of PCT and CRP in severe traumatic brain injury complicated with ventilator-associated pneumonia

作　　者：邓磊[1] 李依[1] 冯璇璘[1] 宋孟龙[1] 杨鹏[1] DENG Lei;LI Yi;FENG Xuan-lin;SONG Meng-long;YANG Peng(Sichuan Academy of Medical&Scienes Provincial Peoples Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]四川省医学科学院·四川省人民医院EICU,四川成都610041

出　　处：《中华医院感染学杂志》2020年第11期1713-1717,共5页Chinese Journal of Nosocomiology

基　　金：四川省卫计委基金资助项目(17PJ125)。

摘　　要：目的分析降钙素原(PCT)、C-反应蛋白(CRP)在诊断重症颅脑外伤(Severe traumatic brain injury,sTBI)合并呼吸机相关性肺炎(Ventilator-associated pneumonia,VAP)中的价值,为临床诊断工作提供参考。方法选取2016年1月-2019年1月四川省医学科学院·四川省人民医院收治的sTBI患者105例为研究对象,对其VAP发生情况进行分析,并于机械通气48 h对患者的PCT、CRP、白细胞计数(WBC)水平进行检测和分析。结果发生VAP患者29例,感染率为27.62%;在机械通气48 h时,感染患者的血清PCT、CRP分别为(0.99±0.63)μg/L、(24.08±14.86)mg/L高于未感染患者(P<0.001),而外周血WBC水平的差异无统计学意义。Logistic多元回归分析结果显示,sTBI患者血清PCT、CRP水平均与VAP的发生具有相关性(P<0.001)。血清PCT、CRP水平诊断sTBI患者VAP的受试者工作特征曲线下面积(AUC)均有统计学意义(P<0.05),分别为0.691和0.641,在Cut-off值下,PCT的诊断灵敏度高于CRP,当将两者进行联合检测时,诊断的AUC和灵敏度均未得到显著提升。结论合并VAP的sTBI患者在机械通气早期会出现血清PCT、CRP水平的升高,这两个指标在诊断sTBI合并VAP中均具有一定的价值,可用于辅助诊断。OBJECTIVE To analyze the values of procalcitonin(PCT)and C-reactive protein(CRP)in the diagnosis of severe traumatic brain injury(sTBI)with ventilator-associated pneumonia(VAP),to provide reference for clinical diagnosis.METHODS A total of 105 patients with sTBI admitted to Sichuan Province Academy of Medical Sciences and Sichuan Provincial People’s Hospital from Jan.of 2016 to Jan.of 2019 were selected as the study subjects.The occurrence of VAP of the patients was analyzed,and the PCT,CRP and WBC levels after of the patients were detected and analyzed after the mechanical ventilation for 48 hours.RESULTS 29 patients had VAP,the infection rate was 27.62%.At 48 hours after mechanical ventilation,the levels of serum PCT and CRP of the infected patients were(0.99±0.63)μg/L and(24.08±14.86)mg/L,respectively,significantly higher than those of the uninfected patients(P<0.001).There was no significant difference in WBC level in peripheral blood between the two groups.Logistic multivariate regression analysis showed that the serum PCT and CRP levels in sTBI patients were correlated with the occurrence of VAP(P<0.001).The area under receiver operator characteristic curve(AUC)of the serum PCT and CRP levels in diagnosing VAP in sTBI patients had significance(P<0.05),which were 0.691 and 0.641,respectively.Under the Cut-off values,the diagnostic sensitivity of PCT was slightly higher than that of CRP.When the two indicators were combined detected,the AUC and the sensitivity of the diagnosis were not significantly improved.CONCLUSION The serum PCT and CRP levels in patients with sTBI complicated with VAP may increase at the early stage of mechanical ventilation.Both of these indicators have certain values in the diagnosis of sTBI complicated with VAP and can be used to assistant diagnosis.

关 键 词：降钙素原 C-反应蛋白 重症颅脑外伤 呼吸机相关性肺炎 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]