降钙素原与白介素-6与急性心力衰竭继发肺部感染的关系

Effects of serum plasma procalcitonin and interleukin-6 in evaluation of the severity of acute heart failure with secondary pulmonary infection

目的:观察分析血清降钙素原(PCT)与白介素-6(IL-6)与急性心力衰竭(心衰)并发肺部感染中的关联性。方法:将急性心衰患者184例分别于发病后第1、2、3、5天抽取静脉血,检测血清IL-6、PCT的变化,同时依据患者临床肺部感染评分及痰培养结果将患者分为单纯心衰组与心衰并发肺部感染组,分析两组患者IL-6、PCT动态变化的意义。结果:心衰发生后第1、2天单纯心衰组与并发肺部感染组炎性反应指标较正常值明显增高。单纯心衰组发生后第2天PCT达到高峰,第3、5天PCT明显下降,降低幅度大于50%。但第3天单纯心衰组有59%患者血清PCT≥2.0μg/L;而继发肺部感染组第1、2天血清PCT水平也表现明显升高,两组比较,差异无统计学意义。但第3天及第5天患者血清PCT水平持续升高或下降幅度<30%。IL-6的动态变化:单纯心衰组发生后IL-6缓慢上升,第3天白IL-6达到高峰,持续升高至第5天下降不明显;而肺部感染组各时点观察IL-6水平持续升高,两组比较,差异无统计学意义。结论:急性心衰发生后,血清PCT水平的动态变化与继发肺部感染有关联。

AIM： To investigate the effects of serum plasma procalcitonin and interleukin-6 in evaluating the severity of acute heart failure with secondary pulmonary infection. METHODS： A total of 184 patients with acute heart failure were included in the study. Based on the clinical pulmonary infection scores and sputum culture results, patients were divided into acute heart failure group and heart failure with secondary pulmonary infection group. Venous blood was collected from patients 1, 2, 3, and 5 days after onset of heart failure and serum interleukin-6 （IL-6） and proealcitonin （PCT） changes were detected. RESULTS ： On the first and second days after the occurrence of heart failure, the inflammatory response indicators in both groups were significantly higher than normal. Proealcitonin （PCT） levels peaked on the second day after onset in acute heart failure group and decreased significantly on the third and fifth day. The rate of decrease was 〉50%. On the third day, serum procalcitonin was ≥12. 0 μg/L in 59% of the patients in the acute heart failure group. Serum procalcitonin levels were also significantly higher in heart failure with secondary pulmonary infectionon the first and second davs. No statistically significantdifference was observed between groups. Serum procalcitonin levels kept increasing on the third and fifth days and/or the rate of decrease was groups, peaked on the fifth day and the 〈 30%. The levels of interleukin-6 slowly increased in the two rate of decline was not obvious. No statistically significant differ- ence was observed between groups （P 〈 0. 05 ）. CONCLUSION： After acute heart failure, the dynamic changes of serum procalcitonin levels are helpful in predicting the severity and prognosis of heart failure.