降钙素原在危重症患者呼吸机相关性肺炎早期诊断中的价值

Clinical observation on diagnostic value of procalcitonin in critically ill patients with ventilator-associated pneumonia

目的探讨血清降钙素原(PCT)在呼吸机相关性肺炎(VAP)中的早期诊断价值。方法选择2009年3月至2010年6月本院重症监护病房行机械通气的危重症患者100例,分为VAP组及非VAP组。检测两组于机械通气前、非VAP组于机械通气7d后、VAP组于机械通气过程中出现炎症表现24h内测定血清PCT、白细胞总数及晨时体温,并行X线胸片检查及支气管深部痰细菌培养鉴定。采用半定量固相免疫测定法检测血清PCT,PCT≥0.5μg/L为阳性。结果机械通气前两组PCT、白细胞计数及晨时体温等方面比较差异无统计学意义(P>0.05),机械通气后VAP组PCT、血常规及早晨8:00时体温较机械通气前显著升高,差异有统计学意义(P<0.05)。结论血清PCT在VAP诊断中有较高敏感性和特异性,早期监测血清PCT对VAP的早期诊断有指导意义。

Objective To explore the diagnostic value of procalcitonin（PCT） quantification in critically ill patients with ventila- tor-associated pneumonia（VAP）. Methods 100 critically ill patients with mechanical ventilation in ICU of our hospital from March 2009 to June 2010 were divided into VAP group and non-VAP group. The serum PCT,white blood cell（WBC） count and morning temperature were determined before treatment in the two groups, on 7 d after mechanical ventilation in the non-VAP group and within 24 h after occurrence of inflammatory manifestations during mechanical ventilation in the VAP group. The serum PCT was detected by the semi-quantitative solid-phase immunoassay with serum PCT≥0. 5μg/L as positive result. Results Serum PCT, WBC count and morning temperature showed no obvious difference before mechanical ventilation in both groups. But the serum PCT,WBC count and morning temperature after mechanical ventilation in the VAP group were obviously elevated than those before mechanical ventilation with statistical difference between them（P〈0.05）. Conclusion Serum PCT has high sensitivity and high specificity in the diagnosis of VAP. Therefore, early monitoring serum PCT level has guidance significance in early diagnosing VAP.