多项炎性指标测定在活动性肺结核诊断中的临床意义

Clinical significance of multiple inflammatory markers in the diagnosis of pulmonary tuberculosis and community-acquired pneumonia

目的探讨活动性肺结核患者 C 反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞介素（IL）-6、降钙素原（PCT）水平变化的特点，并分析这些指标在陈旧性肺结核、社区获得性肺炎患者中鉴别诊断价值。方法测定2012年1月～至2014年7月我院确诊为活动性肺结核、陈旧性肺结核、社区获得性肺炎的118例患者的 CRP、ESR、IL-6、PCT 水平及病原学指标。结果活动性肺结核患者 ESR、CRP、IL-6、PCT 测定的中位数（四分位数间距）分别为14．00（27．00）mm／h、8．92（19．60）mg／L、11．80（23．50）pg／ml 和0．05（0．05）ng／ml；活动性肺结核组 CRP、IL-6、ESR 测定值轻度升高，而陈旧性结核组均在正常范围；社区获得性肺炎组 CRP、IL-6、PCT 测定值高于活动性肺结核组（P ＜0．05），ESR 在两组间比较差异无统计学意义（P ＞0．05）。结论CRP、ESR、IL-6、PCT测定结果可为临床上鉴别活动性肺结核、陈旧性肺结核或社区获得性肺炎提供参考。

Objective To investigate the levels of C-reactive protein（CRP）,blood sedimentation （ESR）,interleukin-6 （IL-6）and procalcition（PCT）in patients with active pulmonary tuberculosis,obso-lete pulmonary tuberculosis and community-acquired pneumonia,and analyze their values for differential diagnosis.Methods 108 patients with active pulmonary tuberculosis,obsolete pulmonary tuberculosis and community-acquired pneumonia from Jan 2012 to Jul 2014 in our hospital were recruited and the levels of CRP,ESR,IL-6,PCT were detected.Results The median values（inter-quartile range）of ESR,CRP,IL-6, and PCT in active pulmonary tuberculosis patients were 14.00（27.00）mm/h,8.92（19.60）mg/L,11.80 （23.50）pg/ml and 0.05（0.05）ng/ml,respectively.The values of CRP,IL-6,ESR were slightly elevat-ed in patients with active pulmonary tuberculosis,but normal in patients with obsolete pulmonary tubercu-losis.The values of CRP,IL-6,PCT in patients with community-acquired pneumonia were significantly higher than those in patients with active pulmonary tuberculosis（P 〈0.05）,whereas the difference of ESR levels between these 2 groups was not statistically significant（P 〉0.05）.Conclusion Comprehensive analysis of CRP,ESR,IL-6,PCT value provides reference information for clinical differential diagnosis in pulmonary tuberculosis,obsolete pulmonary tuberculosis and community-acquired pneumonia.