血清PCT、IL-6、SAA、ESR水平对老年细菌性肺炎的鉴别诊断价值

Value of serum PCT,IL-6,SAA and ESR levels in the differential diagnosis of bacterial pneumonia in the elderly

目的探讨血清降钙素原(PCT)、白细胞介素6(IL-6)、淀粉样蛋白(SAA)、红细胞沉降率(ESR)水平对老年细菌性肺炎的鉴别诊断价值。方法选取2019年3月-2020年4月于北京核工业医院治疗的老年肺炎患者100例作为研究对象,按照不同肺炎类别分为细菌性肺炎组(n=42例)、非细菌性肺炎组(n=58),同时选取同期健康体检者50人作为对照组。分别对三组血清PCT、IL-6、SAA、ESR水平进行测定,比较各指标之间的差异。利用受试者工作特征曲线(ROC)分析各指标对细菌性肺炎和非细菌性肺炎的鉴别诊断效能;对不同严重程度老年细菌性肺炎患者血清PCT、IL-6、SAA和ESR水平进行比较。结果细菌性肺炎组血清PCT、IL-6、SAA及ESR水平分别为(134.25±14.81)ng/L、(71.32±6.07)ng/L、(89.26±10.35)mg/L、(36.52±4.17)mm/h,显著高于非细菌性肺炎组(71.42±7.25)ng/L、(42.52±4.61)ng/L、(14.62±2.37)mg/L、(16.42±2.47)mm/h,差异有统计学意义(P均<0.05)。ROC曲线分析结果表明,PCT、IL-6、SAA和ESR用于鉴别诊断老年细菌性肺炎的AUC值分别为0.854、0.727、0.926、0.818,四者联合鉴别诊断其AUC值为0.973。中低危组老年细菌性感染肺炎患者血清PCT、IL-6、SAA和ESR水平分别为(124.35±14.21)ng/L、(64.51±6.57)ng/L、(71.32±7.45)mg/L、(26.34±3.42)mm/h,显著低于高危组(154.05±16.75)ng/L、(89.57±9.10)ng/L、(125.18±12.51)mg/L、(57.16±6.09)mm/h,差异有统计学意义(P均<0.05)。结论PCT、IL-6、SAA及ESR水平与老年细菌性肺炎患者疾病严重程度有关,检测四者水平对于老年细菌性肺炎的鉴别具有良好的临床意义。

Objective To explore the value of serum procalcitonin(PCT),interleukin-6(IL-6),serum amyloid A(SAA)and erythrocyte sedimentation rate(ESR)levels in the differential diagnosis of bacterial pneumonia in the elderly.Methods A total of 100 elderly patients with pneumonia who were treated in the Beijing Nuclear Industry Hospital from March 2019 to April 2020 were enrolled as the research objects.According to different types of pneumonia,they were divided into bacterial pneumonia group(42 cases)and non-bacterial pneumonia group(58 cases).During the same period,50 healthy controls were enrolled as control group.The levels of serum PCT,IL-6,SAA and ESR in the three groups were measured.The differences in all indexes were compared among the three groups.The efficiency of each index in the differential diagnosis of bacterial pneumonia and non-bacterial pneumonia was analyzed by receiver operating characteristic(ROC)curves.The above serum indexes were compared among elderly patients with different severity of bacterial pneumonia.Results The levels of serum PCT,IL-6,SAA and ESR in bacterial pneumonia group were(134.25±14.81)ng/L,(71.32±6.07)ng/L,(89.26±10.35)mg/L and(36.52±4.17)mm/h,respectively,and were significantly higher than those in non-bacterial pneumonia group(71.42±7.25)ng/L,(42.52±4.61)ng/L,(14.62±2.37)mg/L,(16.42±2.47)mm/h(P<0.05).The results of ROC curve analysis showed that AUC values of PCT,IL-6,SAA and ESR for differential diagnosis of bacterial pneumonia were 0.854,0.727,0.926 and 0.818,respectively.AUC value of their combination was 0.973.The levels of serum PCT,IL-6,SAA and ESR in low-medium risk group were(124.35±14.21)ng/L,(64.51±6.57)ng/L,(71.32±7.45)mg/L and(26.34±3.42)mm/h,respectively and were significantly lower than those in high risk group(154.05±16.75)ng/L,(89.57±9.10)ng/L,(125.18±12.51)mg/L,(57.16±6.09)mm/h(P<0.05).Conclusions The levels of PCT,IL-6,SAA and ESR were closely related to the severity of bacterial pneumonia in the elderly.The detection of the four was of good clinical significance for the identification of bacterial pneumonia.