血清降钙素原与超敏C-反应蛋白和白细胞介素6对重型颅脑损伤肺部细菌感染的临床预测价值

The clinical predictive value of PCT,hs-CRP and IL-6 in severe craniocerebral injury with bacterial lung infection

目的探讨连续监测血清降钙素原（PCT）、超敏C-反应蛋白（hs-CRP）和白细胞介素6（IL-6）对早期评估重型颅脑损伤并发肺部细菌性感染的临床预测价值,为临床治疗提供参考依据。方法 2011年9月-2013年3月医院收治的91例重型颅脑损伤患者,分为脑挫裂伤组37例、原发性脑干损伤组27例、弥漫性轴索损伤组29例;入院1-3d进行PCT、hs-CRP和IL-6水平连续检测,与31名健康组比较分析,采用SPSS13.0进行统计分析。结果 3组重型颅脑损伤患者PCT、hs-CRP和IL-6的水平在不同的时间监测点较对照组均显著增高,差异有统计学意义（P〈0.05）;91例患者中共发生23例感染,感染率为25.27%;发生感染患者入院1-3d血清PCT水平明显升高,且呈上升趋势,与未感染患者比较,差异有统计学意义（P〈0.05）。结论早期动态监测血清PCT、hs-CRP及IL-6水平,可作为细菌感染的预测指标,若采取正确的防治措施,合理使用抗菌药物,可望降低重型颅脑损伤肺部感染的发生率,提高临床治愈率。

OBJECTIVE To study the continuous monitoring of serum procalcitonin （PCT ） ,hypersensitive c‐reac‐tive protein （hs‐CRP） and interleukin 6 （IL‐6） for early evaluation of severe craniocerebral injury complicated by bacterial lung infection so as to provide reference for clinical treatment .METHODS Totally 91 patients with severe craniocerebral injury during Sep .2011 to Mar .2013 in our hospital were enrolled and divided into the group of cerebral contusion and laceration （n=37） ,the group of primary brain stem injury （n=27） ,and the group of dif‐fuse axonal injury （n=29） .The continuous detection of PCT ,hs‐CRP and IL‐6 was conducted at 1 to 3 days of admission and compared with the healthy group . The software SPSS13 .0 was used for statistical analysis . RESULTS The PCT ,hs‐CRP and IL‐6 levels in 91 patients with severe craniocerebral injury were significantly in‐creased compared with the healthy control group at each time points during the three consecutive days ,the differ‐ence was significant （P〈0 .05） .Totally 23 out of 91 patients had bacterial lung infection ,the infection rate was 25 .27% .The PCT level in infected patients was increased significantly at 1 to 3 days of admission ,showing a ris‐ing trend ,the difference was significant compared to the uninfected patients （P〈0 .05） .CONCLUSION Early dynamic monitoring of serum PCT ,hs‐CRP and IL‐6 levels can be used as a predictor of bacterial infection .It is possible to reduce lung infection in severe craniocerebral injury and improve the clinical cure rate through proper control measures and appropriate use of antibiotics .