降钙素原和临床肺部感染评分在呼吸机相关性肺炎早期诊断中的相关性研究

目的研究血清降钙素原（PCT）和临床肺部感染评分（CPIS）在呼吸机相关性肺炎（VAP）早期诊断中的相关性。方法前瞻性观测2009年10月～2010年10月入住急诊ICU且资料完整的接受机械通气超过48h,疑诊为VAP的患者58例。评价PCT和CPIS诊断VAP的敏感性、特异性及相关性。结果 58例疑诊VAP患者中,确诊32例,未确诊26例。两组的PCT和CPIS计数差异有统计学意义（P〈0.05）。以PCT〉0.5μg/L、CPIS〉5分为阈值,对诊断VAP的敏感性分别为71.8%、81.2%,特异性分别为76.9%、65.4%,阳性预测值分别为79.3%、74.3%,阴性预测值分别为68.9%、74.0%。PCT和CPIS的相关系数为0.656（P〈0.05）。结论 PCT作为单一的血清学指标,具有简便、快速的特点,而CPIS与其具有较强相关性。结合PCT和CPIS综合分析,可以显著提高诊断的特异性,从而有效排除诊断假阳性,对VAP的早期诊断具有很好的临床实用性。

Clinical study of the correlation of the procalcitonin(PCT) and clinical pulmonary infection score(CPIS)in the early diagnosis of ventilator-associated pneumonia(VAP)

Objective To study the correlation of the procalcitonin(PCT) and clinical pulmonary infection score(CPIS)in the early diagnosis of ventilator—associated pneumonia(VAP).Methods Prospective study the patients which were admitted to the ICU of emergency department from October 2009 to October 2010,chose 58 cases which were suspected of having VAP,evaluated the sensitivity,specificity and correlation in diagnosing VAP with PCT an CPIS.Results Fifty eight suspects were divided into two groups,one group with 32 case which were confirmed with VAP microbiologically,the other group with the rest of 26 cases.The PCT and CPIS showed obvious difference between the VAP and non-VAP group(all P < 0.05)。Taking PCT>0.5 μg/L and CPIS>5 as the cut-off value,the sensitivity were 71.8% and 81.2% in diagnosing VAP using PCT and CPIS,their specificity were 76.9% and 65.4%,respectively.Their positive predictive rates were 79.3% and 74.3%,respectively.Their negative predictive rates were 68.9% and 74.0%,respectively.The relationship index of PCT and CPIS was 0.656(P < 0.05).Conclusion Serologically detected PCT,is easy and quick to apply,and has the strongly correlativity with CPIS.We can improve the diagnose of VAP in the early stage using PCT combined with CPIS.