降钙素原、C反应蛋白及D-二聚体在预测重症肺炎患者预后中的作用

Effects of procalcitonin,C-reaction protein,and D-dimer on prediction of prognosis of patients with severe pneumonia

目的探讨降钙素原（PCT）、C反应蛋白（CRP）及D-二聚体（D-dimer）水平在判断重症肺炎患者预后中的作用。方法收集83例重症肺炎患者的临床资料,按疾病预后分为死亡组与生存组,回顾性分析患者的一般特征、并存疾病、急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、机械通气和病原菌分布情况,对两组患者PCT、CRP、D-dimer的初始值和峰值进行比较,分析PCT、CRP及D-dimer升高趋势与患者预后的相关性;应用受试者工作特征（ROC）曲线分析PCT、CRP及D-dimer初始值和峰值预测死亡的效能。结果死亡组患者PCT、CRP和D-dimer的初始值和峰值均高于存活组,除D-dimer初始值外,其余数值的差异均有统计学意义（P〈0.01）。PCT、CRP和D-dimer的升高与患者死亡相关,OR（95%CI）分别为3.5（1.4～8.6）、6.9（2.6～18.2）和11.5（3.1～43.2）（P〈0.01）。PCT峰值、APACHEⅡ评分、CRP峰值和D-dimer峰值预测死亡的ROC曲线下面积分别为0.87、0.86、0.81和0.79。结论 PCT、CRP及D-dimer可以反映重症肺炎的严重程度。PCT、CRP及D-dimer较前升高提示预后不良。PCT、峰值是判断预后的良好指标。

Objective To investigate the effects of procalcitonin （ PCT）, C-reaction protein （CRP）, and D- dimer on the evaluation of prognosis of patients with severe pneumonia. Methods Clinical data of 83 patients with severe pneumonia were collected and the patients were divided into the survivor group and non-survivor group according to the prognosis. Clinical characteristics, coexisting diseases, acute physiological and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, mechanical ventilation, and pathogens of patients were retrospectively analyzed. The initial and maximum values of PCT, CRP, and D-direct of two groups were compared. The increasing trend of PCT, CRP, and D-dimer and its correlation with the prognosis were analyzed. The receiver operating characteristic （ROC） curve was adopted to analyze the effects of initial and maximum values of PCT, CRP, and D-dimer on the prediction of mortality. Results The initial and maximum values of PCT, GRP, and D-dimer of the non-survivor group were higher than those of the survivor group. The differences of values were statistically significant （P（0.01） except for the initial value of D-direct. The increase of PCT, CRP, and D-dimer was correlated to the mortality and the odds ratios （OR） （950/0 C/） were 3.5 （1.4 -8.6）, 6.9 （2.6 - 18.2）, and 11.5 （3.1 -43.2） （P〈0. 01）, respectively. Areas under the ROC curve of maximum PCT, scores of APACHE H, maximum CRP, and maximum D-dimer for the prediction of mortality were 0.87, 0.86, 0.81, and 0.79. Conclusion PCT, CRP, and D-direct can reflect the severity of pneumonia. The increase of PCT, CRP, and D-dimer suggests poor prognosis. Maximum PCT is a satisfactory indicator for evaluating the prognosis.