血清降钙素原、C反应蛋白对转诊肺炎合并脓毒症患者预后的预测价值分析

Value of Procalcitonin and C-reaction Protein in Predicting the Prognosis of Transferred Patients with Pneumonia Combined with Sepsis

目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)与急性生理及慢性健康评分标准Ⅱ(APACHEⅡ)评分在转诊肺炎合并脓毒症患者诊断中的相关性,以寻找更为简洁、快速判断其病情严重程度的指标。方法 2009年1月-2010年12月,选取178例转诊肺炎合并脓毒症患者并进行脓毒症分级,对其进行血清PCT和CRP测定,并与APACHEⅡ评分及预后进行相关性分析。结果严重脓毒症组及脓毒性休克组患者血清PCT、CRP水平与APACHEⅡ评分较全身炎症反应综合征组及脓毒症组高(P<0.05);30 d内死亡的患者其血清PCT、CRP水平及APACHEⅡ评分较存活组明显增高(P<0.05);转诊肺炎合并脓毒症患者血清PCT与APACHEⅡ评分呈正相关(r=0.683,P=0.023),与血清CRP水平呈较弱的正相关(r=0.272,P=0.037)。结论对转院肺炎合并脓毒症患者进行血清PCT和CRP测定,对病情评估具有一定临床价值,特别是PCT可作为对转诊肺炎合并脓毒症患者病情程度判断的重要指标,为早期干预及治疗提供依据,值得临床推广应用。

Objective To explore the correlation of serum procalcitonin （PCT）, C-reaction protein （CRP） and acute physiology and chronic health evaluation 1I （APACHE 11 ） in the diagnosis of transferred patients with pneumonia, in order to discover a convenient clinical index for judging the disease severity of transferred pneumonia patients. Methods A total of 178 transferred pneumonia patients treated between January 2009 and December 2010 were chosen to be studied. They were classified based on the severity of sepsis. Both PCT and CRP were determined, and the correlation between them with APACHE II and prognosis was analyzed. Results PCT, CRP levels and APACHE ]1 score of severe sepsis and septic shock transferred pneumonia patients were higher than those of systemic inflammatory response syndrome group and sepsis group patients （P〈0.05）. PCT, CRP levels and APACHE II score of patients who died within 30 days were higher than survivors （P〈0.05）. PCT and CRP levels in transferred patients with pneumonia were positively correlated with APACHE II score （r=0.683, P=-0.023）. Conclusion The determination of PCT and CRP in transferred pneumonia patients is valuable to some extent in diagnosing clinical disease severity, and especially, PCT can be used as a significant index to diagnose the disease severity of transferred pneumonia patients, which provides references to intervene early and cure these diseases.