生物标志物对卒中相关性肺炎早期的诊断价值

Vaule of biomarks in early diagnosis of stroke associated pneumonia

目的：探讨生物标志物对卒中相关性肺炎（ SAP）早期的诊断价值，为临床合理使用抗菌药物提供一定依据。方法选择2013－08～2014－07符合SAP诊断的患者52例（ SAP组），在出现任意一项临床感染症状后6 h内留取血标本进行血清降钙素原（ PCT）、C－反应蛋白（ CRP）、N氨基末端脑钠肽（ NT－proBNP）、D－二聚体（ D－D）、白细胞计数（ WBC）、中性粒细胞比例（ N）及血小板计数（ Plt）检测，使用抗菌药物前留取痰培养标本。选择同时期入住ICU的非脑卒中且不伴有感染的患者38例作为对照组，在入院时采集血样进行上述生物学标志物指标检测。对两组生物学标志物指标进行统计学分析。结果 PCT、CRP为SAP独立诊断因素。当PCT截断值为0．41 ng／mL时，PCT的曲线下面积（AUC）、敏感度、特异度、阳性预测值、阴性预测值分别为0．87、90．39％、78．95％、84．46％、85．71％，高于 CRP（0．82、82．69％、73．68％、81．13％、75．68％，截断值30．68 mg／L）。 G－菌亚组、混合菌亚组的PCT高于G＋菌亚组（ P＜0．01，P＜0．05），G－菌亚组与混合菌亚组之间的PCT差异无统计学意义（P＞0．05），三组间CRP比较差异均无统计学意义（ P＞0．05）。结论 PCT是SAP早期诊断的独立预测因素，PCT对SAP的早期诊断能力高于CRP。单一致病菌引起SAP时，PCT明显增高的SAP患者提示G－菌感染可能性大。

Objective To investigate the effect of biomarkers for early diagnosis of stroke associated pneumonia（ SAP） .To provide a certain basis for clinical rational use of antibiotics.Methods Fifty two cases who consistent with the diagnosis of stroke associated pneumonia from Aug 2013 to Jul 2014 were included into SAP group.Patients in SAP group were collected the blood samples for detection serum procalcitonin （ PCT ） , C -reactive protein （ CRP ） , N -terminal pro brain natriureticpeptide （ NT-proBNP ） , D -dimer, white blood cell count （ WBC ） , percentage of neutrophils （ N ） and platelet count （ PLT） within 6 hours when appear any clinical infection symptoms.Their sputum was cultured before the use of antibiotics.ICU patients without stroke and infection at the same period were served as control group.The patients in control group were also detected the above mentioned indexes. The serum indexes in the two groups were compared by statistical analysis.Results PCT and CRP are independent predictive factors of SAP. The area under the PCT curve （ AUC ） , the sensitivity, specificity, positive predictive value and negative predictive values are 0.87, 90.39%, 78.95%, 84.46% and 85.71%, respectively.The cut off value is 0.41 ng/mL, higher than CRP （ 0.82, 82.69%, 73.68%, 81.13%, 75.68%, cutoff value： 30.68 mg/L）.The PCT index in G-sub-group and mixed bacteria group is higher than G＋sub-group （P〈0.01, P〈0.05）.The PCT index between G＋sub-group and mixed bacteria group has no statistical significance （P〉0.05）.There is no statistical significance of CRP index among all the three groups （P〉0.05）.Conclusion PCT is an independent predictor in early diagnosis of SAP.PCT has better ability than CRP in early diagnosis of SAP.It is more likely to be a G-bacteria infection when PCT is obviously increased in patients with SAP.