血清降钙素原在呼吸道感染疾病中临床应用价值

Clinical application value of serum procalcitonin in respiratory tract infection disease

目的：探讨血清降钙素原（PCT）在呼吸道感染疾病中的临床应用价值.方法：选取2013年1月～2014年2月呼吸道感染病人108例,健康体检人员50例,根据病原学检查及临床表现将入选病例分为细菌感染组57例、非细菌病原体感染组51例及正常对照组50例,分别进行血清降钙素原（PCT）、C反应蛋白（CRP）及外周血白细胞计数（WBC）水平测定与比较,全部病例于治疗前、使用抗菌药物3d、6d及出院前测定血清PCT、CRP、WBC水平并分析比较.结果：治疗前PCT水平在细菌感染组显著升高,为（4.89±1.25） ng/ml、在非细菌病原体感染组轻度升高,为（0.52±0.32） ng/ml、在正常对照组极低,为（0.06±0.04） ng/ml,两两比较差异有统计学意义（P＜0.01）,同时检测CRP及WBC,细菌感染组CRP与WBC均明显高于非细菌病原体感染组,有统计学差异（P＜0.05）;动态监测细菌感染组发现,抗菌药物治疗后血清PCT可快速下降,由（4.89±1.25） ng/ml降至（2.34±2.08）ng/ml,而CRP、WBC在细菌感染被控制后仍维持在高水平,分别为（32.06±11.35）～（25.72±9.57） ng/ml、（11.5±6.7）～（9.2±5.1）×109/L,其回落速度慢于血清PCT;诊断呼吸道细菌感染,以PCT＞0.5ng/ml为界,其敏感性为92.6％、特异性为93.8％,以CRP＞8mg/L为界,其敏感性为87.4％、特异性为50.0％,以WBC＞10×109/L为界,敏感性为60.2％、特异性为61.3％.结论：血清PCT检测可作为呼吸道细菌感染早期诊断指标,对细菌感染诊断具有良好的敏感性和特异性;动态监测PCT水平能反映呼吸道细菌感染的严重程度及抗菌药物的疗效,为临床医师及时调整抗菌药与评估病情转归提供客观依据.

Objective ： To investigate the clinical application value of the serum procalcitonin（PCT） in respiratory tract infection. Methods ： A total of 108 hospitalized patients with respiratory tract infections from January 2013 to February 2014 and 50 healthy persons after physical check were selected in study. All patients were determined the level of serum PCT, C-reactive protein （CIKP） and white blood cell count（WBC） before treatment,after the use of antibiotics for 3 days, 6 days and before discharge.Results ： In pre-antibiotic treatment serum PCT significantly increased in the bacterial infection group （4.89 ± 1.25）ng/ml, mildly increase in the non-bacterial infection group （0.52 ± 0.32）ng/ml and did＇ t increase in healthy control group （0.06 ± 0.04）ng/ml.The difference was statistically significant with each other group（P〈0.01）. While the C1KP and WBC are significantly increased in the bacterial infectious group and non-bacterial infection group. There existed the significant differences between the two groups（P〈0.05）. Dynamic observate PCT and CRP and WBC of the bacterial infection group, serum PCT can rapidly decline at the early infection,from（4.89 ± 1.25） ng/ml to （2.34 ± 2.08）ng/ml while CRP and W13C remain higher after controlling the infection from（32.06 ± 11.35）to（25.72 ± 9.57） ng/mland from（11.5- 6.7）to （9.2 ± 5.1） × 10^9/L and they decline slower than serum PCT. PCT has a good sensitivity（92.6%） and specificity（93.8%） in the bacterial infectious group, and they were all higher than those of ClKP and WBC. Conclusions ： Detection of serum PCT can serve as the early diagnosis indicator of bacterial infection. Serum PCT for the diagnosis of bacterial infection has a high sensitivity and specificity. Detection of serum PCT can dynamically monitor the severity of bacterial infection and reflect the efficacy of antibiotics. The results are superior to CRP and WBC. The results of serum PCT test provide guidelines for clinicians to adjust the antibiotics in time and provide objective evidence to assess the disease prognosis.