降钙素原对感染性心膜炎的诊疗价值

The value of procalcitonin in the diagnosis and treatment of infective endocarditis patients

目的探讨降钙素原（PCT）对感染性心内膜炎（IE）的诊疗价值。方法回顾性分析中国医科大学第一附属医院感染病科2010年6月至2012年6月确诊的20例血培养阳性感染性心膜炎患者的临床资料。结果死亡组患者入院时的CRP、PCT和治疗5d后的PCT质量浓度明显高于存活组患者，死亡组患者的CRP、PCT治疗前后的下降程度明显低于存活组。金黄色葡萄球菌IE和阴性杆菌IE的CRP、PCT质量浓度明显高于草绿色链球菌IE和粪肠球菌IE，PCT〉2μg/ml多见于金色葡萄球菌（金球菌）和阴性杆菌感染。结论降钙素原（PCT）与C-反应蛋白（CRP）在评价感染性心内膜炎（IE）病情严重程度和抗感染治疗效果等方面具有临床指导意义，在评估预后方面PCT略优于CRP；降钙素原的测定水平对感染性心内膜炎菌种有提示意义，有利于指导早期抗菌药物治疗。

Objective To evaluate the role of procalcitonin （PCT） in the diagnosis and treatment of infective endocarditis （IE）. Methods It was a retrospective study of 20 cases diagnosed as IE with positive culture between June 2010 and June 2012 of First Affiliated Hospital of China Medical University, Department of Infectious Diseases. Results The concentration of C - Reactive Protein （CRP） and PCT in the dead group recorded on the first day and the fifth day in the treatment was significant higher than the survival group. The decreased degree of CRP and PCT concentration after treatment in the dead group was much deeper than the survival group. Moreover, the concentration of CRP and PCT in Staphylococcus aureus IE and negative bacilli IE were significant higher than Streptococcus viridans IE or Enterocoecus faecalis IE, which was commonly above 2 μg/ml level. Conclusions Serum procaleitonin, Lined with CRP, has the similar significance in the assessment of infective endocarditis severity, however, PCT is slightly better than CRP in assessing prognosis. The concentration of procalcitonin has implications to the strains of IE pathogen, in the mean time, it＇ s beneficial to guide the early use of antibiotics.