降钙素原在不同细菌感染社区获得性肺炎患儿中的临床价值

Clinical Value of Serum Procalcitonin in Children with Community Acquired Pneumonia Caused by Different Bacteria

目的探讨降钙素原在革兰阳性菌(G+菌)、革兰阴性菌(G-菌)感染社区获得性肺炎患儿中的临床价值。方法收集2011年1-8月湖南省儿童医院所有诊断为社区获得性肺炎的住院患儿降钙素原(PCT)、超敏C反应蛋白(hsCRP)、白细胞计数(WBC)、细菌培养结果等资料,根据细菌培养结果分为G+组和G-组,比较两组患儿PCT、hsCRP、WBC水平的差异。结果符合纳入标准的患儿共122例,其中感染G+菌54例,G-菌68例;G-菌感染者PCT水平高于G+菌感染者(P<0.001),而两组间hsCRP、WBC差异无统计学意义(P>0.05)。以7.65 ng/ml为截值,PCT诊断G-菌感染社区获得性肺炎的敏感度为77.9%,特异度为87.0%,ROC曲线下面积为0.846(95%可信区间0.776～0.917)。结论 PCT对鉴别社区获得性肺炎患儿G+菌、G-菌感染有一定临床价值,可为早期制定抗生素方案提供参考。

Objective To explore the clinical value of serum procalcitonin （PCT） in children with community acquired pneumonia （CAP） caused by gram - positive （G＋ ） and gram - negative （G-） bacteria. Methods The data about the levels of PCT and hsCRP, WBC count, and blood bacterial culture results of all children with CAP hospitalized in the Children＇ s Hospi- tal of Hunan Province from January to August 2011 were collected. According to blood bacterial culture results, the children were divided into G ＋ group and G group. The levels of PCT and hsCRP, WBC count were compared between the two groups. Re- salts One hundred and twenty- two children were subjected in accordance with the selected standard, including 54 patients who were infected by G＋ bacteria and 68 patients who were infected by G- bacteria. The .serum PCT level of G- group was sig- nificantly higher than that of G＋ group （P〈0. 001）. No statistically significant difference was found in hsCRP level and WBC count between the two groups （P〉0.05）. Using a cut- off point of 7.65 ng/ml for PCF, the sensitivity and specificity for G bacteria infection in children with CAP were 77.9% and 87.0%, respectively, the area under the ROC curve was 0. 864 （95% CI 0. 776 - 0. 917）. Conclusions The PCT level has some clinical value in differentiatiiag CAP children from gram - negative bacteria infection and gram-positive bacteria infection, which can provide the reference for physicians to rationally use antibiotic.s in early stage.