降钙素原在急性缺血性脑卒中非溶栓患者合并院内获得性肺炎诊治中的临床价值  

Clinical value of procalcitonin in the diagnosis and treatment of non-thrombolytic acute ischemic stroke patients with hospital-acquired pneumonia

作　　者：褚庆霞 汤倩倩 王晓磊 李超[3] 王宏俊 CHU Qingxia;TANG Qianqian;WANG Xiaolei(Department of Respiratory Diseases,Pukou Branch of Jiangsu People's Hospital,Nanjing 211800,CHINA)

机构地区：[1]江苏省人民医院浦口分院(南京市浦口区中心医院)呼吸内科,江苏南京211800 [2]江苏省人民医院浦口分院(南京市浦口区中心医院)神经内科,江苏南京211800 [3]江苏省人民医院浦口分院(南京市浦口区中心医院)老年医学科,江苏南京211800

出　　处：《江苏医药》2022年第12期1205-1208,共4页Jiangsu Medical Journal

基　　金：江苏省卫生健康委课题项目(Z2021047);江苏省南京市卫生科技发展专项资金项目(YKK18229);江苏省人民医院浦口分院科技发展基金项目(KJ2002-14)。

摘　　要：目的探讨血清降钙素原(PCT)在急性缺血性脑卒中非溶栓患者合并院内获得性肺炎诊治中的临床价值。方法急性缺血性脑卒中非溶栓患者120例分为观察组(发生院内获得性肺炎,78例)和对照组(未发生院内获得性肺炎,42例)。按照美国国立卫生研究院卒中量表(NIHSS)评分标准将观察组分为轻型组(NIHSS评分≤6分,9例)、中型组(6分<NIHSS评分<14分,28例)和重型组(NIHSS评分≥14分,41例)。按照院内获得性肺炎严重程度CURB-65评分标准将观察组分为重症肺炎组(评分≥3分,35例)和轻中症肺炎组(评分2分,43例)。分别在观察组使用抗生素前和对照组人组前检测并比较两组血清PCT及CRP水平。结果观察组血清PCT和CRP水平均高于对照组(P<0.05)。轻型组、中型组和重型组患者血清PCT水平依次升高(P<0.05),而三组血清CRP水平差异无统计学意义(P>0.05)。重症肺炎组PCT水平高于轻中症肺炎组(P<0.05),而两组CRP水平差异无统计学意义(P>0.05)。ROC曲线分析显示,PCT预测急性缺血性脑卒中非溶栓患者入院后发生院内获得性肺炎的AUC为0.998[95%CI(0.000~1.000)],取最佳诊断界值为0.35μg/L时,其预测发生院内获得性肺炎的灵敏度为97.4%,特异度为97.6%。结论PCT在急性缺血性脑卒中非溶栓患者合并院内获得性肺炎的临床诊治中是评估病情和预测预后的重要指标。Objective To investigate the clinical value of serum procalcitonin in the diagnosis and treatment of non-thrombolytic acute ischemic stroke(AIS)patients with hospital-acquired pneumonia(HAP).MethodsA total of 120 non-thrombolytic patients with AIS were divided into two groups of A(with HAP,78 cases)and B(without HAP,42 cases).According to NIHSS scoring for AIS,group A was divided into three subgroups of A1(light AIS,NIHSS≤6 points,9 cases),A2(medium AIS,6 points<NIHSS<14 points,28 cases)and A3(severe AIS,NIHSS≥14 points,41 cases).According to the CURB-65 scoring standard for the severity of HAP,group A was divided into two subgroups of A4(with severe pneumonia,CURB-65 score≥3 points,35 cases)and A5(with mild and moderate pneumonia,CURB-65 score score<2 points,43 cases).Serum levels of procalcitonin and CRP of two groups were detected and compared.ResultsSerum procalcitonin and CRP levels in group A were higher than those in group B(P<0.05).Serum procalcitonin level was increased in an order of group A3>group A2>group A1(P<0.05).There were no significant differences in serum CRP level among groups of A1,A2 and A3(P>0.05).The procalcitonin level of group A4 was higher than that of group A5(P<0.05),while the CRP level of the two groups was not significantly different(P>0.05).ROC curve analysis showed that the AUC of procalcitonin in predicting HAP in non-thrombolytic patients was 0.998[95%CI(0.000-1.000)].Taking 0.35μg/L as the cut-off value,the sensitivity and specificity for procalcitonin to predict HAP were 97.4%and 97.6%,respectively.Conclusion Procalcitonin plays an important role in the clinical diagnosis and treatment of non-thrombolytic AIS patients with HAP.

关 键 词：降钙素原 C反应蛋白 急性缺血性脑卒中 院内获得性肺炎 

分 类 号：R563[医药卫生—呼吸系统]