血清降钙素原在区分儿童社区获得性肺炎病原菌类型中的应用

The value of serum procalcitonin in differentiating pathogen type of childen with community acquired pneumonia

目的探讨降钙素原在鉴别革兰阳性菌(G+菌)和革兰阴性菌(G-菌)感染的儿童社区获得性肺炎(CAP)中的作用。方法以2011年1月至2012年12月于四川省人民医院诊断为儿童社区获得性肺炎的住院患者为研究对象,根据痰细菌培养结果将患儿分为G+菌组和G-菌组,比较两组患儿降钙素原(PCT)、超敏C-反应蛋白(hsCRP)和白细胞(WBC)水平的差异。结果共纳入122例儿童CAP患者,其中G+菌感染58例,G-菌感染64例。G-菌感染者外周血PCT水平显著高于G+菌感染者(13.29±4.30 ng/ml vs 7.22±1.07 ng/ml,P<0.001),而hsCRP(12.64±6.20 mg/L vs 13.27±6.90 mg/L,P>0.05)和WBC计数[(11.28±4.30)×109/L vs(12.43±3.70)×109/L,P>0.05]在两组间的分布差异无统计学意义。受试者工作曲线(ROC)分析提示,PCT=7.50 ng/ml时,PCT诊断G-菌感染儿童CAP的ROC曲线下面积为0.846,其敏感度和特异度分别为81.4%和85.6%。结论 PCT对鉴别儿童CAP患者病原菌类型(G+菌或G-菌)具有一定参考价值。

Objective To investigate the clinical value of serum procalcitonin （PCT） in differentiating the type of pathogens for childen with community acquired pneumonia （CAP）. Methods The childen with CAP hospitalized in Sichuan Provincial People＇s Hospital between January 1st, 2011 to December 31st, 2012 were collected. According to sputum culture results, patients were divided into Grampositive group and Gram-negative group, while the serum levels of procalcitonin （PCT）, high-sensitivity C-reactive protein （hsCRP） and white blood cell （WBC） count were all compared between two groups, respectively. Results A total of 122 patients were collected, including 58 patients with Gram-positive bacterial infection and 64 patients with Gram-negative bacterial infection. The serum PCT level in Gramnegative group was significantly higher than that in Gram-positive group （13.29 ± 4.30 ng/ml vs 7.22 ± 1.07 ng/ml, P 〈 0.001）, while both the levels of serum hsCRP （12.64 ± 6.2 mg/L vs 13.27 ± 6.90 mg/L, P 〉 0.05） and WBC count with （11.27 ± 4.30） × 109/L vs （12.42 ± 3.70） × 109/L, p 〉 0.05）, between Grampositive group and Gram-negative group were with no significant differences. The receiver operating curve （ROC） analysis for identifying Gram-negative bacterial infection showed that the area under ROC curve was 0.846 when PCT was at 7.50 ng/ml, and the its sensitivity and specificity were 81.4% and 85.6%, respectively. Conclusion Serum PCT has a certain value in differentiating childen CAP from Gram-negative and Gram-positive bacterial infections.