血清降钙素原对儿童社区获得性肺炎严重程度的预测价值

Value of serum procalcitonin in evaluating severity of community-acquired pneumonia in children patients

目的探讨血清降钙素原（PCT）对儿童社区获得性肺炎（CAP）严重程度的预测价值。方法选取2011年1月至2012年12月入院的91例儿童CAP住院患者，评估患者血清PCT值与重症肺炎的关系。结果将患者依据诊断标准分为重症肺炎组和非重症肺炎组，其中重症肺炎35例，非重症肺炎56例，两组问PCT值中位数分别为2．65ng／ml，0．16ng／ml，差异有统计学意义（U=344．23，P〈0．001）。以PCT≥0．5ng/ml为阈值时，重症肺炎发生率为69％，而以PCT≥2ng／ml为阈值时，重症肺炎发生率为14％。在91例患儿中，好转出院组与非好转出院组入院时的血清PCT值中位数分别为0．20ng／ml和16．5ng／ml，两者有显著的差异（U=11．262，P〈0．001），此外在重症患儿中，好转出院组与非好转出院组入院时的血清PCT值中位数也有显著的差异，分别为1．91ng/ml与19．0ng／ml（U=9．452，P〈0．001）。根据PCT值绘制重症CAP患儿的受试者工作特征曲线（ROE），曲线下面积为0．873（95％CI：0．778～0．969）。PCT值取2．0ng/ml时，预测儿童重症CAP的敏感度为97．8％，特异度为51．9％。结论血清PCT水平能够比较准确地评估CAP患儿的严重程度，可以用于预测儿童CAP患者的严重程度，帮助临床医生及时采取相关措施。

Objective To investigate the value of serum procalcitonin （PCT） as a predictor in evaluating the severity of community - acquired pneumonia（CAP） in children patients. Methods A total of 91 children patients with CAP from 2011 to 2012 were collected. Then the relation between serum procalcitonin and severity of pneumonia was evaluated. Results Patients were divided into severe group （ n = 35 ） and non - severe group （ n = 56） according to corresponding diagnosis criterion. The serum PCT level was significantly higher in the severe group （median 2. 65ng/ml） than that in the non-severe group （median 0. 16ng/ml） （U = 344. 23 ,P 〈0. 001 ）. Among all the patients, when the threshold of PCT level was set as 0. 5ng/ml, the incidence of severe patients was 69%, however, when the threshold was set as 2ng/ml, the incidence of severe patients was 14% o Among all the 91 cases, patients who improved well had significantly lower original PCT levels than the remaining （median 0, 20ng/ml, 16. 5ng/ml respectively; U = 11. 262 ,P 〈 0. 001 ）. Furthermore, this was also observed in the severe cases （ median 1.91ng/ml, 19. 0ng,/ml, respectively; U = 9. 452,P 〈 0. 001 ）. The receiver operating characteristic （ROC） curve was drawn by the serum PCT values of patients. The area under the ROC curve was 0. 873（95% confidential interval （CI） ：0. 778 -0. 969）. At a PCT cut - off of no lower than 2. 0ng/ml, the sensitivity and specificity to predict the severity of children patients with CAP was 97.8% and 51.9%, respectively. Conclusions Serum PCT level can accurately evaluate the severity of children patients with community - acquired pneumonia in some degree. It may be used as a good indicator to evaluate CAP severity in children patients, which might help clinicians take correct steps.