动态监测血清降钙素原对重型颅脑损伤患者感染及预后判断的意义

The clinical significance of dynamic determination of serum procalcitonin levels in judgement of infection and prognosis in patients with severe craniocerebral injury

目的动态监测血清降钙素原（PCT）对重型颅脑损伤患者感染及预后判断的意义。方法选择80例重型颅脑损伤患者，按是否感染分为感染组和非感染组。感染组又分为好转亚组及未愈亚组。比较感染组和非感染组急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分、格拉斯哥昏迷量表（GCS）评分，比较各组入ICU第1、3、5天血清PCT、白细胞计数（WBC）、C反应蛋白（CRP）及白细胞介素（IL）-6水平。结果感染组48例，非感染组32例，两组年龄、性别构成及GCS评分比较差异无统计学意义（P〉0．05）；感染组APACHEⅡ评分高于非感染组[（21．71±7．13）分比（15．32±6．17）分]，差异有统计学意义（P〈0．05）。感染组入ICU第1天血清PCT高于非感染组[（2．15±1．79）ng／L比（0．56±0．47）ng／L]，差异有统计学意义（P〈0．05）；两组WBC、CRP及IL6比较差异无统计学意义（P〉0．05）。感染组入ICU第3天血清PCT、WBC、CRP、IL．6均高于非感染组，差异有统计学意义（P〈0．05）。感染组入ICU第5天血清PCT为（3．09＋1．98）ng／L，非感染组为（1．06＋0．63）ng／L，两组比较差异有统计学意义（P〈0．05）。好转亚组（38例）入ICU第5天WBC、CRP、IL-6分别为（15．13±6．32）×10^9/L、（103．56±40．62）mg／L、（230．41±121．83）．g／L，未愈亚组（10例）分别为（18．62±8．89）×109／L、（134．38±34．16）mg／L、（268．73±138．12）ng／L，两组比较差异有统计学意义（P〈0．05）。好转亚组入ICU第1、3、5天血清PCT均低于未愈亚组，差异有统计学意义（P〈0．05）。结论动态监测血清PCT水平的变化可以作为判断重型颅脑损伤患者感染及预后的有效指标。

Objective To explore the clinical significance of dynamic determination of serum procalcitonin （PCT） levels in judgment of infection and prognosis in patients with severe eraniocerebral injury. Methods A total of 80 patients with severe craniocerebral injury were selected and they were divided into infection group and non-infection group. Infection group was divided into improved group and non-improved group. Acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score and Glasgow coma scale （GCS） score was compared between infection group and non-infection group. The level of serum PCT, white blood cell count （WBC）, C-reactive protein （CRP） and interleukin （IL）-6 was compared on the first,third,fifth day of admission in intensive care unit among these groups. Results Infection group in 48 patients, and non-infection group in 32 patients. There was no significant difference in age, sex and GCS score between two groups （P 〉0.05）. APACHE Ⅱ score in infection group was higher than that in non-infection group [ （21.71 ± 7.13 ） scores vs. （ 15.32 ± 6.17） scores ], and there was significant difference （P 〈 0.05 ）. The level of serum PCT on the first day of admission in intensive care unit in infection group was higher than that in non-infection group[ （2.15 ± 1.79） ng/L vs. （0.56 ± 0.47） ng/L] ,and there was significant difference（P 〈 0.05 ）. There was no significant difference in WBC, CRP and IL-6 between two groups （P 〉 0.05）. The level of serum PCT, WBC, CRP, IL-6 on the third day of admission in intensive care unit in infection group was higher than that in non-infection group, and there was significant difference （P 〈 0.05 ）. The level of serum PCT on the fifth day of admission in intensive care unit in infection group was higher than that in non-infection group [ （ 3.09 ± 1.98 ） ng/L vs. （ 1.06 ±0.63 ） ng,/L ], and there was significant difference （P 〈 0.05 ）. WBC, CRP, IL-6 on the fifth day of admission in intensive care unit was （15.13 ± 6.32） × 10^9/L, （103.56 ±40.62） mg/L, （230.41 ± 121.83） ng/L in improved group （38 cases）, and （18.62 ± 8.89） × 10^9/L, （ 134.38 ± 34.16） mg/L, （268.73 ± 138.12） ng/L in non-improved group（ 10 cases） ,and there were significant differences between two groups （P 〈 0.05 ）. The level of serum PCT on the first, third, fifth day of admission in intensive care unit in improved group was lower than that in non-improved group, and there was significant difference （P〈 0.05）. Conclusion The alteration of serum PCT level may be used as one of the effective predictors for infection in patients with severe craniocerebral injury and for their prognosis.