血清降钙素原在老年重症肺炎降阶梯治疗转换节点中的应用价值?

目的：评价血清降钙素原(procalcitionin,PCT)在老年重症肺炎患者降阶梯治疗转换节点中的应用价值。方法选择2012年6月至2014年12月南京市中心医院急诊科及内科重症监护病房收治的老年重症肺炎患者共80例,入院后每天采静脉血测定 PCT 水平,根据肺部感染全身性炎症反应综合征(SIRS)及局部反应监测转换节点的 PCT 水平,观察抗生素使用时间、机械通气时间、二重感染发生率、住院时间、住院费用及疗效等指标。结果治愈者与未治愈者转换节点上的血清 PCT 浓度分别为(1.82±1.21)ng/mL 和(4.70±3.25)ng/mL,两组比较,差异有统计学意义(t =-6.67,P <0.001)。转换节点上的 PCT 工作特征曲线(receiver operating characteristic curve,ROC 曲线)下面积为0.80,最佳临界值为2.39 ng/mL,灵敏度为80.00%,特异度为85.70%。结果表明,转换节点上的 PCT 值可较好地预测老年重症肺炎临床预后。PCT≥2.39 ng/mL 组二重感染发生率、抗生素使用时间、机械通气时间、住院时间及住院费用均明显高于 PCT<2.39 ng/mL 组(P <0.05)。结论以 PCT数值2.39 ng/mL为界点,在指导老年重症肺炎患者的降阶梯治疗转换节点中有一定的临床价值。

Application Value of Procalcitonin in Switching Node of Order De-escalation Treatment for Elderly Patients with Severe Pneumonia

Objective To Evaluate the application value of procalcitionin(PCT)in the switching node of order de-escalation treatment for elderly patients with severe pneumonia. Methods A total of 80 cases of severe pneumonia patients in our emergency treatment & medical intensive care unit admitted from June 2012 to December 2014 were selected and their PCT levels were measured based on their venous blood.Indicators including the average service time of antibiotics,mechanical ventilation time,double infection,length of stay,hospitalization expenses and curative effect were observed according to SIRS and PCT numerical value of local reaction monitoring transition point.Results The mean of PCT in transition point for healed patients was significantly higher than the unhealed group (t=-6.67,P <0.001).The ROC curve was 0.80 and cut off value was 2.39 ng/mL.The values of average service time,mechanical ventilation time,double infection,hospital days,hospitalization expenses were higher in the group with a PCT level of at least 2.39 ng/mL than in the group with less than 2.39 ng/mL (P < 0.05 ). Conclusion Taking PCT numerical value 2.39 ng/mL as a threshold point,it has some clinical value in the switching node of order de-escalation treatment for elderly patients with severe pneumonia.