降钙素原在不同细菌感染社区获得性肺炎患儿中的临床价值

目的探讨降钙素原在革兰阳性菌（G＋菌）、革兰阴性菌（G-菌）感染社区获得性肺炎患儿中的临床价值。方法收集2011年1—8月湖南省儿童医院所有诊断为社区获得性肺炎的住院患儿降钙素原（PCT）、超敏c反应蛋白（hsCRP）、白细胞计数（WBC）、细菌培养结果等资料，根据细菌培养结果分为G＋组和G-组，比较两组患儿PCW、hsCRP、WBC水平的差异。结果符合纳入标准的患儿共122例，其中感染G＋菌54例，G-菌68例；G-菌感染者PCT水平高于G＋菌感染者（P〈0．001），而两组间hsCRP、WBC差异无统计学意义（P〉0．05）。以7．65ng/ml为截值，PCT诊断G-菌感染社区获得性肺炎的敏感度为77．9％，特异度为87．0％，ROC曲线下面积为0．846（95％可信区间0．776～0．917）。结论PCT对鉴别社区获得性肺炎患儿G＋菌、G菌感染有一定临床价值，可为早期制定抗生素方案提供参考。

Clinical Value of Serum Procalcitonin in Children with Community Acquired Pneumonia Caused by Different Bacteria

Objective To explore the clinical value of serum procalcitonin(PCT) in children with community acquired pneumonia(CAP) caused by gram-positive(G+) and gram-negative(G-) bacteria.Methods The data about the levels of PCT and hsCRP,WBC count,and blood bacterial culture results of all children with CAP hospitalized in the Children’s Hospital of Hunan Province from January to August 2011 were collected.According to blood bacterial culture results,the children were divided into G+ group and G-group.The levels of PCT and hsCRP,WBC count were compared between the two groups.Results One hundred and twenty-two children were subjected in accordance with the selected standard,including 54 patients who were infected by G+ bacteria and 68 patients who were infected by G-bacteria.The serum PCT level of G-group was significantly higher than that of G+ group(P<0.001).No statistically significant difference was found in hsCRP level and WBC count between the two groups(P>0.05).Using a cut-off point of 7.65 ng/ml for PCT,the sensitivity and specificity for G-bacteria infection in children with CAP were 77.9% and 87.0%,respectively,the area under the ROC curve was 0.864(95%CI 0.776-0.917).Conclusions The PCT level has some clinical value in differentiating CAP children from gram-negative bacteria infection and gram-positive bacteria infection,which can provide the reference for physicians to rationally use antibiotics in early stage.