重症社区获得性肺炎患者降钙素原的变化和临床意义

目的探讨血清降钙素原（PCT）变化对重症社区获得性肺炎（SCAP）患者的疗效评价及临床意义。方法对2009年1月一2011年4月收治的60例SCAP患者，在人院后第0、1、2、3、4、5天留取静脉血2mL，检测血清PCT、血常规和C．反应蛋白（CRP）。根据人院后第6天氧合指数（PaO：／FiO2）〉250、停用血管活性药物，影像学肺部渗出出现吸收，以格拉斯哥昏迷评分〉10分，尿量≥0．5mL／（kg·d）为标准，将患者分为好转组和预后不良组，符合以上标准进入好转组（42例），反之进入预后不良组（18例）。用SAS9．0软件对资料进行统计学分析，尸值〈O．05为有统计学意义。结果患者第0天的PCT和CRP呈正相关（r=0．38，P=0．00）。好转组的PCT最快出现明显下降，在治疗后第48小时下降29％。以PCT下降30％为判断预后的标准，第48小时的灵敏度和特异度分别为66．87％和85．50％，而第72、96和120小时的灵敏度分别为70．05％、79．88％、83．10％，特异度分别为100．00％、75．23％、100．00％。结论治疗后48h的PCT下降幅度可为早期判断SCAP患者的治疗效果、更换临床药物提供依据，并可作为判断患者预后的一项临床指标。

Change of Procalcitonin Kinetice in Patients with Severe Community-acquired Pneumonia and Its Clinic Value

Objective To explore procalcitonin （PCT） dynamically in severe community-acquired pneumonia （SCAP） patients to evaluate the effects of different kinds of medical treatments and assess the clinical significance of the change of PCT. Methods All of the selected 60 SCAP patients treated from January 2009 to April 2011 met the standards of IDSA/ ATS Guidelines for CAP. There were 38 males and 22 females, with an average age of 66.3 years. The sterile venous blood specimen samples were collected from the patients at day 0 to day 5. PCT and C-reactive protein （CRP） were measured by enzyme linked immunosorbent assay throughout the research. At day six, based on oxygenation index （PaO2/FiO2） ratio higher than 250, inflammation absorption on chest X ray after vasoactive agents were stopped, Glasgow scores higher than 10 and urine volume equal to or higher than 0.5 mL/（kg ＇ d）, we divided the patients into recovery group and deterioration group. Data were analyzed by SAS 9.0 software, and P〈 0.05 was considered to be statistically significant. Results The analysis results showed that PCT and CRP bore a significantly positive relationship on day 0 （r=0.38, P=0.00）. The research also indicated that PCT had a faster declining rate than CRP and white blood cells count throughout the clinical treatment. The average of PCT declined 29% in 48 hours. Following the criterion of PCT decrease by 30%, the research showed that PCT had a higher sensibility and specificity （66.87% and 85.50%, respectively） in 48 hours than 72 hours （70.05% and 100.00%）, 96 hours （79.88% and 75.23%）, and 120 hours （83.10% and 100.00%）. Conclusion Following the criterion of PCT decrease by 30% after using antibiotics can be an clinical objective index to guide the use of antibiotics and provide the basis for clinical application and prognosis.