血清降钙素原、C-反应蛋白及白细胞介素6在重症肺炎患者中的临床应用

The clinical study of serum PCT,CRP and IL-6 in patients with severe pneumonia

目的观测血清降钙素原(PCT)、C-反应蛋白(CRP)及白细胞介素6(IL-6)在重症肺炎患者病程中的水平及变化趋势,探讨其临床意义。方法选择2010年12月至2011年6月行机械通气的重症肺炎患者42例作为观察组,其中存活组25例,死亡组17例,检测重症肺炎患者在入住重症医学科的第1、3、7天及转出ICU(或死亡)当天的血清PCT、CRP及IL-6水平及APACHEⅢ评分。结果第3天、第7天及转科或死亡当天,死亡组血清PCT水平分别为(15.06±4.16)μg/L、(16.18±3.78)μg/L及(19.50±2.09)μg/L,比存活组高(P值分别为0.049、0.041及0.039);第7天及转科或死亡当天,死亡组血清CRP水平分别为(94.87±11.67)mg/L,(117.56±11.43)mg/L,高于存活组(P值为0.025及0.019);观察期间存活组血清IL-6水平与死亡组无统计学差异(P值分别为0.183、0.371、0.843及0.424)。在观察期期间,存活组的血清PCT、CRP水平逐渐下降,死亡组逐渐上升;两组血清IL-6水平均逐渐下降。PCT、IL-6与APACHEⅢ评分呈直线相关(相关系数分别为0.447、0.602)。结论 PCT、CRP及IL-6在重症肺炎患者血清中水平升高,能反映病程严重程度;PCT与IL-6一定程度上与预后相关。

Objective To investigate the serum concentration and the trends of PCT, CRP and IL-6 of severe pneumonia patients. Methods 42 patients with severe pneumonia who received mechanical ventilation, 25 patients were enrolled as the survival group,and 17 patients were enrolled as the non-survival group. Calculated the APACHE Ⅲ scores for the severe pneumonia patients at day 1,3,7 and the day of discharge from ICU or death. Blood specimens were collected at the same points. Results At day 3,7 and the day of discharge from ICU or death, the serum PCT of the non-survival group was higher than the survival group. At day 7 and the day of discharge from ICU or death,the levels of the non-survival group were higher than the survival group. Within the period, the serum PCT and CRP of the survival group decreased, while the non-survival group increased. The serum IL-6 of the two groups decreased gradually. Positive correlations both were found between the serum PCT and the APACHE Ⅲ scores, and the serum IL-6 and the APACHE Ⅲ scores. Conclusions The severe pneumonia patients have high serum levels of CRP, PCT and IL-6. Positive correlations are found between the serum PCT and APACHE Ⅲ scores, and between the serum IL-6 and APACHE llI scores. The levels of PCT and IL-6 could reflect the severity of the disease and have an effect on the prognosis prediction.