血清降钙素原及C-反应蛋白水平在恶性肿瘤患者感染监测中的评价

Value of joint detection of serum procalcitonin and C-reactive protein in monitoring of infections in malignant tumor patients

目的评估联合检测C-反应蛋白(CRP)及降钙素原(PCT)水平对恶性肿瘤患者感染的诊断和预后指导的价值,以指导合理应用抗菌药物。方法选择2012年4月-2014年2月在肿瘤科接受住院的恶性肿瘤患者78例,根据患者培养结果分为感染组56例(细菌感染46例、非细菌感染10例)和未感染组22例,检测并比较两组患者CRP和PCT水平;将细菌感染患者随机分为对照组与观察组,各23例,对照组给予常规抗感染治疗,观察组通过检测PCT和CRP变化制定优化抗菌药物方案,比较两组抗菌药物治疗疗程、费用及二重感染、不良反应发生率。结果 PCT和CRP水平感染组患者均高于对照组患者,细菌感染患者均高于非细菌感染患者,差异均有统计学意义(P<0.05);观察组抗菌药物治疗疗程、费用及二重感染、不良反应发生率分别为(8.7±2.5)d、(1.6±0.1)万元及4.3%、8.7%,均明显低于对照组的(16.2±5.5)d、(0.9±0.1)万元及21.7%、34.8%,差异有统计学意义(P<0.05)。结论联合检测PCT和CRP对肿瘤患者感染的发生尤其是鉴别是否细菌性感染具有重要价值,且可以作为抗菌药物治疗的重要依据。

OBJECTIVE To evaluate the value of joint detection of C-reactive protein（CRP）and procalcitonin（PCT）in diagnosis of infections in malignant tumor patients and in guidance of prognosis so as to guide the reasonable use of antibiotics.METHODS A total of 78 malignant tumor patients who were treated in the department of oncology from Apr 2012 to Feb 2014 were enrolled in the study and divided into the infection group with 56cases（46cases of bacterial infections,10 cases of non-bacterial infections）and the non-infection group with 22 cases according to the culture results;the levels of CRP and PCT were detected and compared between the two groups;the patients with bacterial infections were randomly divided into the control group and the observation group,with23 cases in each;the control group was given the conventional anti-infection therapy,while the observation group was treated with the optimized drug therapy programs based on the change of levels of PCT and CRP;the drug therapy course,cost,and the incidence of superinfection,adverse reactions were observed and compared between the two groups.RESULTS The levels of PCT and CRP of the infection group were higher than those of the control group,and the levels of PCT and CRP of the patients with bacterial infections were higher than those of the patients with non-bacterial infections,there was significant difference（P〈0.05）.The antibiotic treatment course of the observation group was（8.7±2.5）days,significantly shorter than（16.2±5.5）days of the control group;the antibiotic cost of the observation group was（1.6±0.1）ten thousand yuan,significantly more than（0.9±0.1）ten thousand yuan of the control group;the incidence of superinfection of the observation group was 4.3%,significantly lower than 21.7% of the control group;the incidence of adverse reactions of the observation group was8.7%,significantly lower than 34.8% of the control group,there was significant difference（P 0.05）.CONCLUSION The joint detection of PCT and CRP has significant value in diagnosis of infections in the tumor patients,especially for the identification of the bacterial infections,which can provide guidance for the use of antibiotics.