降钙素原对早产儿呼吸机相关性肺炎早期诊断的意义

目的评估血清降钙素原(procalcitonin,PCT)检测在早产儿呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)中的诊断意义。方法选择NICU收治的126例早产儿,根据有无机械通分为机械通气组和非机械通气组(对照组)。其中机械通气组的81例按是否发生VAP分为VAP组和非VAP组。回顾性分析机械通气组在机械通气前及48h后血清PCT、WBC、CRP的检测结果,并与同期对照组上述指标进行对照比较。结果机械通气前VAP组、非VAP组及对照组的PCT、WBC、CRP之间差异无统计学意义(P0.05)。机械通气48h后,三组间WBC计数比较差异无统计学差异(P0.05);而PCT、CRP三组间不全相等,VAP组高于非VAP组和对照组,差异有统计学意义(P均0.000),非VAP组与对照组差异无统计学意义(P0.05)。PCT和CRP诊断早产儿呼吸机相关性肺炎的ROC、AUC分别为0.936和0.702,差异有统计学意义(P=0.000)。结论 PCT对新生儿VAP早期诊断的准确性高于CRP、WBC。

Evaluation of serum procalcitonin as a early diagnostic marker of premature ventilator-associated pneumonia.

Objective To evaluate the diagnostic value of procalcitonin (PCT) in premature ventilator-associated pneumonia (VAP). Methods 126 cases of preterm infants were divided into mechanical ventilation group and non mechanical ventilation group(the control group).81 preterm infants on ventilators were divided into VAP group and non-VAP group depending on whether the patients developed VAP.The levels of blood PCT,C-reactive protein (CRP) and the white blood cell (WBC) of preterm infants with mechanical ventilation group before the mechanical ventilation and after 48 hours were retrospectively analyzed,and compared with the control group. Results There were no significant differences of PCT,WBC,CRP in the VAP group,non-VAP group and the control group before mechanical ventilation (P>0.05).At 48 hours after mechanical ventilation,there were no significant differences of WBC in three group (P>0.05).But there was not all equal of PCT or CRP between the three groups,and the PCT and CRP showed obvious difference in VAP group compared with non-VAP group and the control group( all P<0.000 ),and there were no significant differences of PCT and CRP in non-VAP group and the control group (P>0.05).The area under the curve (AUC) of receiver-operation characteristics (ROC) was 0.936 for PCT and 0.702 for CRP to diagnose premature ventilator-associated pneumonia,there was significant differences (P=0.000). Conclusion The PCT for early diagnosis of neonatal VAP has higher accuracy than CRP and WBC.