血清C反应蛋白、降钙素原及乳酸在重症肺炎中的变化及临床意义

Serum C-reactive protein,procalcitonin and lactic acid levels in patients with severe pneumonia and its clinical significance

目的探讨血清C反应蛋白(CRP)、降钙素原(PCT)和乳酸在重症肺炎中的变化,以及三者的临床意义。方法选取重症监护病房(ICU)2011年2月—2014年6月收治的重症肺炎患者89例。患者分别在入院后的第1、4、7天及好转后转出或死亡前检测血清CRP、PCT和乳酸水平,并根据患者预后情况分为两个组,存活组和死亡组。采用免疫比浊法检测CRP、电化学发光法检测PCT,化学分析法检测乳酸,进而比较分析存活和死亡组患者血清CRP、PCT和乳酸改变情况。结果存活组中,伴随病程的进展,在第4和第7天及转出前,患者血清CRP出现不同程度的降低,或降低到正常水平,与第1天相比,第4和第7天及转出前三者数值差异具有统计学意义,同样PCT值、乳酸水平降低,P<0.01。在死亡组中,患者血清CRP始终保持升高水平,在第4和7天及转出前均保持较高数值,与存活组比较,死亡组血清CRP水平明显增高,PCT浓度也增高,乳酸水平同PCT和CRP水平,P<0.01。结论伴随重症肺炎患者病情进展,血清CRP、PCT及乳酸水平出现不同程度的增高,在判断重症肺炎预后中血清CRP、PCT及乳酸具有重要的临床意义,动态监测三者数值变化有助于判断重症肺炎患者病情程度及治疗效果评价,对治疗方案进行及时有效的调整,降低患者病死率。

Objective To investigate the serum levels of C-reactive protein （CRP） ,procalcitonin （PCT） and lactate levels in patients with severe pneumonia and evaluate their elinical value. Methods The clinical data of 89 cases of severe pneu- monia in ICU from February 2011 to June 2014 were reviewed retrospectively, and divided into survived and non-survival group according to the outcome of patients. The serum levels of CRP,PCT and lactate on 1,4,7 days after admission,at dis- charge or prior to death were detected in both groups by immune turbidimetry （for CRP）, electrochemical luminescence method （for PCT） or chemical analysis method （for lactate ）, respectively. The results were analyzed and compared. Results In the survival group, with the alleviation of the condition, the serum level of CRP, PCT and lactate on d 4 and d 7 after the admission and at discharge decreased or recovered to the normal levels as compared with d 1, the difference was statistically significant（P 〈0.01 ）. In the non-survival group, with the development of the condition, the serum level of CRP, PCT and lactate on d 4 and d 7 after the admission and prior to death increased and maintained at a higher level as compared with the survival group,the difference was statistically signifieant（P 〈 0.01 ）. Conclusion The serum level of CRP, PCT and lactate rise with the progression of severe pneumonia. The dynamic monitoring of the serum level of CRP, PCT and lactate should contribute to the judgment of the condition and prognosis of patients, the evaluation of therapeutic efficacy and the improvement of regimen timely, thus reduce mortality rate of patients with severe pneumonia.