血清C反应蛋白变化在社区获得性肺炎病情评估中的价值

Significance of detecting serum C-reactive protein in evaluating community-acquired pneumonia

目的探讨血清C反应蛋白(CRP)水平的变化在社区获得性肺炎(CAP)病情及预后评估中的价值。方法收集CAP患者356例,初诊时和治疗后第4天检测血清CRP水平,观察符合重症肺炎病例数和随访30 d病死率。采用多元回归分析的方法评估预测价值。结果纳入研究范围的356例患者中,符合重症肺炎34例,30 d病死率是7.0%。较低水平的CRP对30 d病死率显示较高的阴性预测值,CRP<100 mg/L是减少重症肺炎(OR 0.22)(P<0.01)和30 d病死率(OR 0.17)(P<0.05)风险的独立危险因素。263例患者第4天重复测量了血清CRP水平。第4天的CRP水平下降少于50%或升高增加重症肺炎(OR 4.9)(P<0.01)和30 d病死率(OR 20.6)(P<0.01)风险。结论 CRP是评估CAP严重程度的独立预测因素。CRP<100 mg/L提示重症肺炎风险和30 d病死率降低。第4天CRP水平下降不足50%或上升提示重症肺炎风险和30 d病死率增加。

Objective To evaluate the significance of detecting serum C-reactive protein（CRP） in evaluating community-acquired pneumonia.Methods Serum levels of CRP were measured in 356 patients both on admission and on the 4th day.The case unmber of severe pneumonia and 30-day mortality were recorded.The value of predictive tests was assessed using multivariate logistic regression.Results The case unmber of severe pneumonia was 34 and 30-day mortality was 7.0%.Low CRP levels showed a high negative predictive value for excluding 30-day mortality.The CRP level of 100 mg/L was independently associated with the lower case number of severe pneumonia（OR=0.22）（P0.01） and 30-day mortality（OR=0.17）（P0.05）.The CRP level that failled to falling by 50% or more on the 4th day was independently associated with increased severe pneumonia（OR=4.9）（P0.01） and 30-day mortality （OR=20.6）（P0.01）.Conclusion Serum level of C-reactive protein is an independent marker in assessment of the severity of community-acquired pneumonia.Serum level of CRP100 mg/ L on admission predicts a low risk for severe pneumonia and 30-day mortality.The CRP level that failled to falling by 50% or more on the 4th day indicates an increase of the risk for severe pneumonia and 30-day mortality.