血清炎性指标联合评估社区获得性肺炎严重程度的价值  

The value of serum inflammatory markers combined to assess the severity of community-acquired pneumonia

作　　者：方威[1] 张泽文[2] 邱进锋 王君[1] 黄靖宇[1] 李湖桂 林达佳[1] 尹俊[1] FANF Wei;ZHANG Zewen;QIU Jinfeng;WANG Jun;HUANG Jingyu;LI Hugui;LIN Dajia;YIN Jun(Department of Laboratory,the Second Affiliated Hospital of Medicine School of Shantou University,Shantou,Guangdong 515041,China;Department of Hematology,the Second Affiliated Hospital of Medicine School of Shantou University,Shantou,Guangdong 515041,China;Department of Respiratory Medicine,the Second Affiliated Hospital of Medicine School of Shantou University,Shantou,Guangdong 515041,China)

机构地区：[1]汕头大学医学院第二附属医院检验科,广东汕头515041 [2]汕头大学医学院第二附属医院血液科,广东汕头515041 [3]汕头大学医学院第二附属医院呼吸内科,广东汕头515041

出　　处：《重庆医学》2021年第19期3310-3313,共4页Chongqing medicine

基　　金：广东省医学科学技术研究基金项目(B2019211)。

摘　　要：目的探讨血清炎性指标联合评估社区获得性肺炎(CAP)严重程度的价值。方法选择2018年4月至2020年4月该院呼吸内科收治的60例CAP患者为研究对象,所有患者入院前根据CAP CURB-65评分系统得分分为轻度20例,中度24例,重度16例。所有患者于清晨抽取空腹静脉血5 mL,连续采集4份血样,测定C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素(IL)-6、IL-10水平,对比不同感染程度患者血清炎症因子水平,利用ROC曲线分析CRP、PCT、IL-6、IL-10水平评估中重度CAP的价值,通过Kappa分析CRP、PCT、IL-6、IL-10水平联合评估中重度CAP的价值。结果CAP病情越严重,CRP、PCT、IL-6、IL-10水平越高,差异均有统计学意义(P<0.05)。经ROC曲线分析显示CRP、PCT、IL-6、IL-10水平对中重度CAP有一定的评估价值,曲线下面积(AUC)分别为0.730、0.677、0.729、0.744;CRP、PCT、IL-6、IL-10联合评估中重度CAP的灵敏度为0.880,特异度为0.867,准确度为0.875,Kappa值为0.875。结论CRP、PCT、IL-6、IL-10联合可用于CAP严重程度的评估,同时联合评估灵敏度高,特异度好,值得临床推广应用。Objective To explore the value of a combined serum inflammatory index to assess the severity of community-acquired pneumonia(CAP).Methods A total of 60 patients with CAP admitted to the respiratory medicine department of the hospital from April 2018 to April 2020 were selected as the study subjects.There were 20 mild cases,24 moderate cases and 16 severe cases according to the CAP CURB-65 scoring system before admission.All patients were drawn 5 mL of fasting venous blood in the early morning,and four consecutive blood samples were collected to measure the levels of the C-reactive protein(CRP),procalcitonin(PCT),interleukin(IL)-6 and IL-10.The levels of serum inflammatory factors in patients with different levels of infection were compared.The levels of CRP,PCT,IL-6 and IL-10 were analyzed by the ROC curve and the value of moderate to severe CAP was evaluated.And the value of the moderate to severe CAP was evaluated by the Kappa analysis with the levels of CRP,PCT,IL-6 and IL-10 combined.Results The more severe the CAP condition,the higher the levels of CRP,PCT,IL-6 and IL-10,and the difference was statistically significant(P<0.05).ROC curve analysis showed that the levels of CRP,PCT,IL-6 and IL-10 had certain evaluation value for the moderate to severe CAP,and the areas under the curve were 0.730,0.677,0.729 and 0.744,respectively.The sensitivity,specificity,accuracy and Kappa value of the CRP,PCT,IL-6 and IL-10 in the combined evaluation of the moderate to severe CAP were 0.880,0.867,0.875 and 0.875,respectively.Conclusion The combination of the CRP,PCT,IL-6 and IL-10 can be used to evaluate the severity of CAP.At the same time,the combined evaluation has high sensitive and good specificity,which is worthy of clinical application.

关 键 词：社区获得性肺炎 严重程度 C反应蛋白 降钙素原 白细胞介素-6 白细胞介素-10联合 

分 类 号：R563.1[医药卫生—呼吸系统]