血清降钙素原在社区获得性肺炎诊治中的临床应用价值

目的:检测社区获得性肺炎(CAP)患者血清降钙素原(PCT)的水平,阐明其在CAP诊治中的意义。方法:选择127例CAP患者和30名健康对照者,127例CAP患者以合格痰标本细菌培养结果分为细菌培养阳性组(n=54)与细菌培养阴性组(n=73);根据重症肺炎诊断标准将细菌培养阳性组患者分为重症肺炎组(n=13)和非重症肺炎组(n=41)。采用双抗夹心免疫化学发光法检测研究对象血清PCT水平、白细胞(WBC)计数、中性粒细胞百分比(NEUT%)和C反应蛋白(CRP)水平。结果:治疗后第8天,细菌培养阳性组、细菌培养阴性组和健康对照组研究对象血清PCT水平比较差异无统计学意义(P>0.05);治疗后第8天,细菌培养阳性组和细菌培养阴性组研究对象血清PCT水平低于入院后第1天(P<0.05);重症肺炎组患者血清PCT水平明显高于非重症肺炎(P<0.01),重症肺炎组患者WBC计数、NEUT%和CRP水平虽均高于非重症肺炎组患者,但差异无统计学意义(P>0.05);以细菌培养阳性为诊断细菌感染的金标准,血清PCT水平诊断细菌性CAP的敏感度和特异度均优于NEUT%和WBC计数。结论:血清PCT水平对诊断CAP有一定的辅助价值,可指导判断CAP是否为细菌感染、评估肺炎的严重程度和停用抗生素的时机。

Clinical value of serum procalcitonin in diagnosis and treatment of community acquired pneumonia

Objective To detect the level of serum procalcitonin(PCT) in the patients with community acquired pneumonia(CAP),and to clarify its significance in diagnosis and treatment of CAP.Methods 127 CAP patients and 30 cases of normal individuals were selected. According to the sputum bacterial culture results,127 CAP patients were divided into positive bacteria culture group (n=54)and negative bacteria culture group (n=73);according to the diagnostic criteria of severe pneumonia,the bacteria culture positive group was divided into severe pneumonia group (n=13) and non-severe pneumonia group(n=41). The levels of serum PCT,the white blood cell (WBC) count,neutrophil percentage(NEUT%) and levels of C-reactive protein (CRP) of the objects were detected by double antibody sandwich method.Results After treated for 8 d,the levels of serum PCT of the objects in positive bacteria culture group and negative bacteria culture group and normal control group had no significant differences. After treated for 8 d, the levels of serum PCT of the objects in positive bacteria culture group and negative bacteria culture group were lower than that of the objects on the first day after treatment.The level of serum PCT of the patients in severe pneumonia group was significantly higher than that in non-severe pneumonia group;the WBC count,NEUT% and CRP level of the patients in severe pneumonia group were higher than those in non-severe pneumonia group,but the difference was not statistically significant. When consindering the bacterial culture as the gold standard for diagnosis of bacterial infection,the sensitivity and specificity of the serum level in diagnosis of bacterial CAP were superior to NEUT% and WBC count.Conclusion The level of serum PCT plays a role in the diagnosis of CAP,and it could help to judge whether the CAP patient gets a bacterial infection and assess the severity of pneumonia and the discontinuation of antibiotics.