肺炎严重度指数、CURB-65评分和血清降钙素原对老年社区获得性肺炎病情及预后的评估价值

目的 探讨肺炎严重度指数（pneumonia severity index,PSI）、CURB-65评分和血清降钙素原（procalcitonin,PCT）评估老年社区获得性肺炎（community acquired pneumonia,CAP）住院患者病情严重程度及预后的价值.方法 选取入住江苏省盐城市第三人民医院呼吸内科CAP患者191例,用PSI、CURB-65评分系统进行评估,同时测定患者PCT.比较两种评分系统、血清PCT对患者病情严重程度以及患者预后的价值（患者住院30 d后的存活情况）.结果 PSI低风险组79例,中风险组90例,高风险组22例,血清PCT中位数分别为0.27 ng/mL、0.41 ng/mL、1.13 ng/mL,30 d死亡人数分别为4、12、10例,30d死亡率分别为5.1％、13.3％、45.5％. CURB-65评分低风险组85例,中风险组90例,高风险组16例,血清PCT中位数分别为0.22 ng/mL,0.45 ng/mL,0.69 ng/mL,30 d死亡人数分别为6、13、7例;30d死亡率分别为7.1％、14.4％、43.8％.死亡组PSI、CURB65评分及血清PCT中位数明显高于存活组（P＜0.001）;3个风险组血清PCT水平存在显著差异,随着风险级别的增高,血清PCT水平明显升高（P＜0.001）.结论 PSI、CURB-65评分和血清PCT可有效评估老年CAP患者病情严重程度及预后.

Evaluation of severity and prognosis of community acquired pneumonia in elderly patients by Pneumonia Severity Index,CURB-65 and serum procalcitonin

Objective Pneumonia Severity Index （PSI）,the Confusion-Urea-Respiratory Rate-Blood pressure-65 （CURB-65） and serum procalcitonin were used to evaluate the severity and prognosis of community acquired pneumonia （CAP） in elderly patients.Methods One hundred and ninety one elderly inpatients with CAP were enrolled in our hospital.PSI and CURB-65 were used to evaluate the severity,and the serum procalcitonin was measured.The value of two systems and serum procalcitonin in estimating severity and prognosis （30-day survivor rate） was evaluated.Results According to PSI,there were 79,90,22 patients in low-risk,intermediate-risk and high-risk category and the median of serum procalcitonin were 0.27 ng/mL,0.41 ng/mL and 1.13 ng/mL,respectively.Non-survivors were 4,12,10 and the 30-day mortality rate were 5.1％,13.3％,45.5％,respectively.According to CURB-65,there were 85,90,16 patients in lowrisk,intermediate-risk,high-risk category and the median of serum procalcitonin were 0.22 ng/mL,0.45 ng/mL and 0.69 ng/mL,respectively.Non-survivors were 6,13,7 and the 30-day mortality rate were 7.1％,14.4 ％,43.8 ％,respectively.Compared with survivors,non-survivors had higher PCT levels,PSI and CURB-65 （P all ＜ 0.001）.PCT levels increased significantly with increased risk level as assessed by PSI and CURB-65 （P＜0.001）.Conclusion PSI、CURB-65 and serum procalcitonin are useful in evaluation of severity and outcome of CAP in elderly patients.