降钙素原对高龄社区获得性肺炎患者病情的预测价值研究

Clinical values of serum procalcitonin in community acquired pneumonia in aged patients

目的探究降钙素原(PCT)对高龄社区获得性肺炎患者病情的预测价值。方法选取2012年3月至2013年9月该院收治的高龄社区获得性肺炎(CAP)患者40例,作为观察组,其中中重度CAP患者18名,轻度CAP患者22名;另选取20例健康高龄志愿者作为对照组。于清晨抽取所有观察组患者和志愿者的空腹静脉血,离心取血清,冰存温度为-20℃,C-反应蛋白(CRP)采用自动免疫散射速率比浊法测定,降钙素原(PCT)采用半定量法测定,同时检测患者WBC计数和中性粒细胞百分比。结果对照组健康志愿者的血清CRP和PCT评分、中性粒细胞百分比明显较观察组社区获得性肺炎患者低(P<0.001),WBC计数较观察组低(P<0.05)。以CRP≥10 mg·L-1诊断CAP时,敏感性为78.3%、特异性为63.1%、准确性为76.4%;以PCT≥0.3μg·L-1诊断CAP时,敏感性为86.9%、特异性为84.2%、准确性为86.9%;以WBC>10×109·L-1诊断CAP时,敏感性为47.5%、特异性为84.3%、准确性为70.7%。以PCT≥0.3μg·L-1为阳性界值时,其敏感性和特异性最高,对CAP的诊断准确性最高。结论 CRP、PCT评分、中性粒细胞百分比、WBC计数可作为诊断高龄社区获得性肺炎的指标,且PCT诊断CAP的敏感性和特异性较好;PCT可作为评估高龄社区获得性肺炎严重程度的指标。

Objective To explore the clinical values of serum procalcitonin in community acquired pneumonia in aged patients.Meth-ods We selected 40 community acquired pneumonia patients admitted in the First People’s Hospital of Zhaoqing from March 201 2 to September 201 3 as the observation group.CRP was measured by using immunity-turbidity method;PCT was determined by Brahms PCT-Q and WBC was counted in serial blood samples from 40 patients with community acquired pneumonia and 20 healthy people.Re-sults Taking CRP≥1 0 mg·L^-1 as accurate rate,the sensitivity,specificity,accuracy were 78.3%,63.1%,76.4% ,respectively;taking PCT≥0.3 μg·L^-1 as the standard,the sensitivity,specificity,accuracy were 84.2%,90.3%,86.9%,respectively;taking WBC＆gt;1 0 ＆#215;1 09 ·L^-1 as the standard,the sensitivity,specificity,accuracy were 47.5%,84.3%,70.7%,respectively.Serum CPR and PCT scores,the percentage of neutrophils and WBC in the control group were significantly lower than those in the observation group（P＆lt;0.05）.Conclusions The levels of CRP,PCT and WBC count show a significant correlation with the diagnosis of CAP and PCT have higher sensitivity and specificity in the diagnosis of CAP.The level of PCT can be used as a severity index to evaluate the elderly com-munity-acquired pneumonia.