降钙素原在典型病原菌及非典型病原菌致社区获得性肺炎的鉴别诊断研究

目的：通过测定典型病原菌及非典型病原菌致社区获得性肺炎（CAP）患者的血清降钙素原（PCT）水平，探讨其鉴别诊断的价值。方法回顾性分析222例CAP患者，根据病原菌的不同，分为典型病原菌组（139例）及非典型病原菌组（83例）两组，比较两组患者的PCT、CRP 及WBC，并绘制PCT和CRP的ROC曲线，根据曲线下面积评价其对上述两组病原菌所致CAP的鉴别诊断价值。结果典型病原菌组患者PCT水平为0.31 ng/ml（四分位数间距：0.10 ng/ml，2.58 ng/ml），明显高于非典型病原菌组0.17 ng/ml（四分位数间距：0.08 ng/ml，0.66 ng/ml）（P＜0.05）；且两组患者PCT的阳性率比较有统计学意义（0.96比0.67）（P＜0.05）。绘制PCT鉴别CAP病原菌的ROC曲线，曲线下面积（AUC）为0.783，在临界值为0.95 ng/ml时，其敏感度为0.932，特异度为0.894。结论血清PCT测定有助于CAP病原菌的鉴别诊断，可作为初始选择抗生素治疗的依据。

Value research of procalcitonin in the identification between typical and atypical community-acquired pneumonia

Objective To study the differential value of serum procalcitonin （PCT） between typical and atypical community-acquired pneumonia（CAP）. Methods The serum procalcitonin of patients with typical bacterial CAP （139 cases） and atypical bacterial CAP （83 cases） were retrospectively analyzed and compared with C-reactive protein （CRP）, leukocyte count （WBC）. ROC curves were described and the differential value of PCT and CRP were evaluated according to AUC. Results The level of PCT was significantly higher in patients with typical bacterial CAP than in patients with atypical bacterial CAP 0.31 ng/ml（Interquartile ranges： 0.10 ng/ml, 2.58 ng/ml） vs. 0.17 ng/ml（Interquartile ranges：0.08 ng/ml, 0.66 ng/ml）, P＆lt;0.05];And the positive rate of PCT was statistically significant between the two groups, （0.96 vs. 0.67）（P＆lt;0.05） .The AUC of ROC curve was 0.783. At the cut-off value of 0.95 ng/ml, the sensitivity was 0.932 and the specificity was 0.894. Conclusion Serum procalcitonin contributes to differential diagnosis on the etiology of pneumonia and could have a crucial influence on the initial antimicrobial therapy.