降钙素原等炎性相关指标在感染性心内膜炎预后判断中的作用

Values of PCT and other Inflammation-related Markers for the Prognosis in Patients with Infective Endocarditis

目的本研究旨在评估降钙素原（procalcitionin,PCT）,C-反应蛋白（C-reactive protein,CRP）、血小板平均体积（mean platelet volume,MPV）、血浆D-二聚体等指标在预测感染性心内膜炎（infective endocarditis,IE）患者并发症发生等方面的价值。方法回顾性分析2000~2013年期间,45例治疗前有PCT、CRP、MPV、D-二聚体等检测指标的IE患者的临床资料,评估上述指标在病情及预后判断中的价值。结果有并发症的IE患者,其入院时外周血PCT、CRP、MPV、WBC数值明显高于那些无并发症者,两组间比较差异有统计学意义（P〈0.01）。抗生素治疗后,45例IE患者MPV值（9.5±0.8）fl较抗生素治疗前（10.9±1.2）fl显著下降（P=0.002）。13例并发血栓形成患者,其血浆D-二聚体浓度（4.75±3.36）μg/ml显著高于无血栓形成组（2.25±2.45）μg/ml,两组比较差异具有统计学意义（P〈0.05）。结论PCT、CRP、MPV有可能成为IE患者并发症发生的良好预测指标,血浆D-二聚体水平与IE患者血栓形成有密切关系。

Objective The aim of this study was to evaluate the prognostic value of Procalcitonin（PCT）,D-dimer,Mean platelet vo1ume（MPV）and C-reactive protein（CRP）for clinical outcome in patients with Infective Endocarditis（IE）.Methods A retrospective analysis was performed from2000 to 2013.All 45 patients were diagnosed with IE.Before starting antibiotic therapy,PCT,CRP,D-dimer,MPV and WBC were measured.Evaluated the above markers’ value in patients’ condition and prognosis.Results The peripheral blood concentration values of PCT,CRP,MPV,WBC in patients with complications or death were significantly higher than those of patients who had no complications,there were significant differences between the two groups（P〈0.01）.After antibiotic treatment,MPV values（9.5±0.8）fl of 45 patients with thrombosis decreased significantly compared with the values（10.9±1.2）fl before.The plasma D-dimer concentration（4.75±3.36μg）of 13 patients with thrombosis was significantly higher than thrombosis group（2.25±2.45μg）（P 〈0.05）.Conclusions PCT,CRP and MPV are predictors of complication in IE.D-dimer assays are also suggested in the prediction of embolism in patients with IE.Clinicians should be aware of the possibility of systemic embolism in IE patients with elevated D-dimer levels.