颈髓损伤术后医院获得性肺炎影响因素及PCT与CRP的诊断价值

目的探究颈髓损伤术后医院获得性肺炎(HAP)的影响因素,分析降钙素原(PCT)、C-反应蛋白(CRP)的诊断价值。方法回顾性分析2017年2月-2019年2月河北医科大学第三医院239例行颈髓损伤术患者的病例资料,根据有无发生HAP进行分组,分为HAP感染组(61例)和非HAP感染组(178例)。单因素及多因素Logistic回归分析颈髓损伤术后HAP的感染因素,观察患者PCT、CRP水平的诊断价值。结果行颈髓损伤术后HAP发生率为25.52%(61/239);两组颈髓损伤术后患者的年龄、颈髓损伤节段、日本骨科协会(JOA)评分、住院时间,差异有统计学意义(P<0.05);Logistic回归分析结果,颈髓损伤节段(OR=1.236)、JOA评分(OR=3.214)、住院时间(OR=1.317)为颈髓损伤术后HAP的影响因素;术后,HAP感染组患者PCT、CRP水平高于非HAP感染组(P<0.05);PCT曲线下面积(AUC)大于CRP,特异度高于CRP(P<0.05)。结论颈髓损伤术后患者HAP发生率较高,颈髓损伤节段、JOA评分、住院时间为颈髓损伤术后HAP的影响因素,同时PCT可作为HAP的首选诊断指标,CRP可作为辅助诊断指标,为临床预防诊断HAP提供参考依据。     

Procalcitonin in preoperative diagnosis of abdominal sepsis

Background and aims The present study attempted to identify the diagnostic significance of procalcitonin (PCT) in acute abdominal conditions as well as the range of concentrations relating to diagnosis of abdominal sepsis. Materials and methods This was prospective clinical study. The study included 98 consecutive patients with acute abdominal conditions, divided in sepsis and systemic inflammatory response syndrome (SIRS) group. Results PCT concentrations on admission were significantly higher in the sepsis group than in the SIRS group (median [interquartile range] 2.32 [7.41] vs 0.45 ng/ml [2.62]). A cutoff value of 1.1 ng/ml yielded 72.4% sensitivity and 62.5% specificity. In a group of patients with abdominal symptoms lasting for more than 24 h, a cut-off value of 1.1 ng/ml yielded higher sensitivity (82.9%) and higher specificity (77.3%). Conclusion Our results suggest that PCT measurements may be useful for early, preoperative diagnosis of abdominal sepsis.     

重症监护病房脓毒症患者降钙素原的临床研究

目的　探讨血浆降钙素原 (PCT)在重症监护病房 (ICU)脓毒症患者发病过程中的变化及其诊断价值。方法　采用双抗夹心免疫荧光发光法定量分析 36例脓毒症患者血浆中PCT含量和动态变化 ,并与 2 4例非脓毒症患者及 2 0例健康人对照分析。结果　脓毒症患者中首次测定PCT含量显著高于非脓毒症组和对照组 (P <0 0 1)。动态观察发现PCT随着病情好转逐渐降至正常 ,而 11例死亡患者的PCT因病情恶化呈上升趋势。结论　PCT定量分析是一种快速、灵敏的检测手段 ,对于尽早发现脓毒症、判断其病情及预后具有重要价值。     

Pleural fluid and serum procalcitonin as diagnostic tools in tuberculous pleurisy

BACKGROUND: Diagnosis of tuberculous pleuritis is difficult because of its nonspecific clinical presentation and decreased efficiency of traditional diagnostic methods. We investigated the use of procalcitonin (PCT) concentration in tuberculous pleuritis diagnosis. METHODS: A prospective clinical study was performed with two different patient groups. A total of 28 patients were included: 18 with tuberculosis and 10 with nontuberculous pleurisy. Serum and pleural fluid PCT concentrations were evaluated before treatment. RESULTS: Serum and pleural fluid PCT concentrations were statistically different between tuberculous and nontuberculous pleurisy groups (P = 0.012 and P = 0.004, respectively), even though they were not elevated in relation to the cut-off level of 0.5 ng/mL. A positive and significant correlation was detected between serum and pleural fluid PCT levels (r = 0.49, P = 0.008). Diagnostic specificity and sensitivity values for serum and pleural fluid PCT in discriminating tuberculous from nontuberculous pleurisy were 80% and 72.2%, and 90% and 66.7% at the 0.081 and 0.113 ng/mL cut-off values, respectively. CONCLUSION: Relative to the current cut-off level of 0.5 ng/mL, PCT concentration is not a useful parameter for the diagnosis of tuberculous pleurisy. Because there were PCT levels in patients with tuberculous pleurisy that were below the current cut-off level but were significantly different from those of the nontuberculous group, the use of PCT should be further investigated.     

降钙素原在细菌感染性疾病诊断中的应用探讨

目的评价血清降钙素原(PCT)在细菌感染性疾病实验诊断中的价值。方法采用半定量的胶体金免疫结合法,测定35例细菌感染性疾病住院患者及15例非细菌感染性疾病住院患者的PCT,并同期测定患者C-反应蛋白(CRP)与中性粒细胞碱性磷酸酶(NAP)。结果35例细菌感染性疾病患者PCT阳性28例,阳性率80.0%;CRP测定阳性30例,阳性率85.7%,NAP测定阳性26例,阳性率74.3%;同期15例非细菌感染性疾病患者PCT均为阴性,而CRP阳性率66.7%(10/15),NAP阳性率26.7%(4/15)。结论PCT检测应用于细菌感染性疾病,可作为早期快速鉴别细菌感染的实验室新指标。     

Value of serum procalcitonin, neopterin, and C-reactive protein in differentiating bacterial from viral etiologies in patients presenting with lower respiratory tract infections

The values of procalcitonin (PCT), neopterin, and C-reactive protein (CRP) alone and in combination to differentiate bacterial from viral etiology in patients with lower respiratory tract infections (LRTIs) were evaluated. Sera obtained on the day of hospitalization for LRTI from 139 patients with confirmed bacterial etiology and 128 patients with viral etiology were examined. A further 146 sera from healthy Chinese subjects with no infection were included as controls. The area under the receiver operating characteristic (ROC) curve (area under curve [AUC]) for distinguishing bacterial from viral infections was 0.838 for CRP and 0.770 for PCT (P < 0.05). The AUC for distinguishing viral from bacterial infections was 0.832 for neopterin (P < 0.05). When the markers were used in combination, AUC of ROC (CRP/neopterin) was 0.857, whereas (CRP x PCT)/neopterin was 0.856. Combination of 2 or all 3 of the biomarkers may improve the discriminatory power in delineating bacterial versus viral etiology in LRTI.     

降钙素原与C-反应蛋白在小儿重症肺炎早期诊断中的价值

目的:探讨降钙素原(procalcitonin,PCT)与C反应蛋白(C-reaction protein,CRP)在小儿重症肺炎早期诊断中的价值.方法:对我院87例重症肺炎患儿根据病原学检测分为3组,即细菌性肺炎组、病毒性肺炎组、支原体肺炎组,另选取我院体检中心20例同期无感染的健康儿童为对照组,对3组小儿重症肺炎87例和20例健康对照组的血清同时进行PCT、CRP、WBC 3项平行检测,并做对比分析.结果:细菌性肺炎组PCT、CRP、WBC 3项结果均明显高于对照组,支原体肺炎组PCT、CRP 2项结果均明显高于对照组,病毒性肺炎组PCT、CRP、WBC 3项结果均与对照组相近;PCT在细菌性肺炎组血清水平明显高于其他组,阳性率为94.2％,CRP在细菌性肺炎组、支原体肺炎组血清水平明显高于病毒性肺炎组,阳性率分别为97.1％、92.8％,病毒性肺炎组PCT、CRP血清水平均未出现明显增高.结论:PCT、CRP在重症肺炎早期诊断中有较高的阳性检出率,可作为重症肺炎早期鉴别诊断指标.PCT、CRP均增高为细菌性肺炎,单独CRP增高为支原体肺炎;PCT、CRP均不增高可能为病毒性肺炎.     

降钙素原在慢性阻塞性肺疾病急性加重期诊治中的应用

在慢性阻塞性肺疾病急性加重期(AECOPD)过多使用抗菌药物,是临床中的一个严重问题。降钙素原是一个重要的炎症标志物,在早期诊断AECOPD是否存在细菌感染方面具有很高的特异性和敏感性,并且对指导AECOPD抗菌药物使用具有重要的临床意义。目前已引起临床医师的高度重视。     

降钙素原在非中性粒细胞减少肿瘤发热患者中的临床应用

目的探讨降钙素原在非中性粒细胞减少肿瘤发热患者中的意义。方法某三甲医院住院的非中性粒细胞减少的肿瘤发热患者153例,于发热24h内及之后72h分别测定血浆降钙素原水平,比较不同原因发热患者血浆降钙素原水平。结果脓毒血症组血浆降钙素原基线水平明显高于局部感染组、无微生物病原学检测结果的感染组及肿瘤相关发热定组。与基线水平相比,脓毒血症组、局部感染组、无微生物病原学检测结果的感染组72h后PCT明显下降,但肿瘤相关发热组72h PCT水平无统计学差异。结论血浆降钙素原水平可作为非中性粒细胞减少肿瘤患者使用抗菌药物的一个重要指标。