社区获得性肺炎住院患者血清降钙素原与肺炎严重程度和预后的关系

Values of serum procalcitonin in predicting severity and prognosis of community-acquired pneumonia in-patients

目的考察血清降钙素原水平与社区获得性肺炎(CAP)住院患者严重程度和预后的关系。方法回顾性分析住院患者数据库中,2009年7月～2010年7月收治的CAP患者的临床资料。结果 324例CAP住院患者中,212例(182例普通CAP、22例重症肺炎和14例死亡病例)纳入本研究。212例患者入院时平均血降钙素原为(0.22±0.34)μg.L-1,血中性粒细胞数平均为(8.92±2.47)×109.L-1,静脉抗生素使用时间为(8.7±2.6)d,平均住院日为(9.2±2.4)d,PSI评分为67.8±33.5,CURB-65评分为2.12±0.45。血降钙素原水平与PSI评分、CURB-65评分、静脉抗生素使用时间和平均住院日的相关系数分别为0.845,0.22,0.404和0.443。重症肺炎患者和死亡者初诊时血降钙素原水平分别为(5.87±2.83)μg.L-1和(2.42±1.28)μg.L-1。入院时血降钙素原水平>0.5μg.L-1预测死亡的敏感度和特异度分别为0.714和0.844。结论初诊时血降钙素原水平对社区获得性肺炎严重程度、住院时间和预后的评估具有一定参考价值,值得进一步研究。

Aim To investigate the relationship of serum procalcitonin to severity and prognosis of community-acquired pneumonia in-patients.Methods Retrospective analysis was made of community-acquired pneumonia in-patients admitted to hospital from July 2009 to July 2010.Results Among 324 cases of community-acquired pneumonia admitted,248 cases were included for analysis.The mean levels of serum procalcitonin,neutrophil number,average duration of intravenous antibiotic therapy,average hospital stay,PSI scale and CURB-65 score were（0.22±0.34） μg·L-1,（8.92±2.47）×109 ·L-1,（8.7±2.6）days,（9.2±2.4）days,67.8±33.5,2.12±0.45.The correlation indices of serum procalcitonin to PSI and CURB-65 score and duration of intravenous antibiotic therapy,average hospital stay were 0.845,0.22,0.404 and 0.443,respectively.The mean procalcitonin levels of severe CAP and deaths were（5.87±2.83） μg·L-1 and（2.42±1.28） μg·L-1,respectively.The sensitivity and specificity of serum procalcitonin more than 0.5 μg·L-1 on admission were 0.714 and 0.844 in predicting death.Conclusion The serum level of procalcitonin on admission is correlated with severity of community-acquired pneumonia in-patients,and PCT≥0.335 μg·L-1 may indicate poorer prognosis.