C-反应蛋白测定用于医院获得性肺炎诊疗与预后的评价

Diagnostic and Prognostic Value of C-reactive Protein in Hospital-acquired Pneumonia

目的测定C-反应蛋白(CRP)水平并与体温、白细胞计数进行比较,观察其用于医院获得性肺炎(HAP)诊疗及预后的价值。方法每天测定患者的体温、白细胞计数和CRP浓度,择日进行继发器官衰竭评分(SOFA);观察患者治愈、病情稳定转出重症监护病房(ICU)或死亡;根据预后分为存活组和死亡组进行回顾性分析。结果抗菌治疗后CRP比率有4种反应模式:快反应、慢反应、无反应、双相反应;快反应和大部分慢反应的患者存活,无反应和双相反应的患者全部死亡;差异有统计学意义。结论CRP比率的变化与HAP病情的变化相关,CRP比率快速下降预示病情改善;CRP比率无反应或双相反应时,提示预后不良。

OBJECTIVE To assess the diagnostic and prognostic value of C-reactive protein （CRP） levels, body temperature and white blood cell （WBC）count for hospital-acquired pneumonia （HAP）. METHODS Temperature, and concentration of CRP and WBC count of the patients were determined daily, and fixed a day for sequential organ failure assessment（SOFA）. Then observed the prognosis be cured, stable out of ICU or death. Patients were divided into death and survival groups according to the prognosis and analyzed retrospectively. RESULTS There were four response modes of CRP ratio after antibacterial treatment： fast response, slow response,nonresponse and biphasic response. All patients with fast response and most patients with slow response survived, whereas all patients with nonresponse and biphasic response were died （P〈0.05）. CONCLUSIONS The value of CRP ratio is correlated with hospital-acquired pneumonia patient＇s clinical conditions. The value of rapidly declined CRP ratio indicates that the patient＇s clinical conditions are improving and unresponse and biphasic response of it indicates bad prognosis.