联合检测降钙素原与高敏C反应蛋白在卒中相关性肺炎中的诊断和预测价值

Diagnostic and Prognostic Value of Combination of Serum Procalcitonin and High Sensitivity C Reactive Protein in Stroke-Associated Pneumonia

目的探讨脑卒中患者外周血降钙素原(PCT)、高敏C反应蛋白(hs-CRP)水平变化与卒中相关性肺炎(SAP)的相关性。方法连续纳入神经内科脑卒中患者106例,动态测定血PCT及hs-CRP变化,75例确诊为SAP的患者,根据PSI评分分为重症SAP组和轻症SAP组,并与非SAP组、对照组进行比较分析。结果重症SAP组、轻症SAP组血清PCT及hs-CRP浓度明显高于非SAP组,差别有统计学意义[PCT:(6.3±3.2)vs(0.5±0.1)μg/L,(5.6±1.3)vs(0.5±0.1)μg/L;hs-CRP:(28.5±7.2)vs(4.6±1.3)mg/L,(10.6±2.3)vs(4.6±1.3)mg/L,均为P<0.05),且重症SAP组血清PCT及hs-CRP浓度和持续时间明显高于轻症SAP组(P<0.05)。第5,7d血清PCT水平与PSI评分呈正相关,第3,5,7d血清hs-CRP水平与PSI评分呈正相关。以血清PCT(3.5μg/L)、hs-CRP(8.1mg/L)为界,诊断SAP的灵敏度分别为94%,91%,特异度分别为90%,75%。结论联合检测血清PCT和hs-CRP可作为SAP的早期诊断及治疗预后的指标。

Objective To investigate the relationship between the levels of serum procalcitonin（PCT）and high sensitivity C reactive protein（hs-CRP）and stroke associated pneumonia（SAP）.Methods 106 patients with acute stroke were consecutively enrolled. The levels of serum PCI and hsCRP were dynamically tested,and clinical pulmonary infection scores（PSI）was assessed. 75 patients with stroke-associated pneumonia（SAP）were divided into the serious and mild SAP group according to PSI. The levels of serum PCI and hs-CRP were compared among these groups（including SAP and nonSAP group,normal control group）. Results The concentrations of serum PCI and hs-CRP in SAP group were significantly higher than that of non-SAP and normal control group,respectively（P〈0.05）. The concentrations and durations of serum PCI and hs-CRP in serious SAP group was significantly higher and longer than that of mild SAP group,respectively（P〈0.05）. There was significantly correlation between PTC with PSI scorers on 5and 7dpost-stroke. Also,the positive statistical correlation was found between hs-CRP levels and PSI scorers on 3,5and 7dpost-SAP. The optimal cut-off point for the PCT and hs-CRP level as determined by the ROC analysis was 3.5μg/L and 8.1 mg/L,respectively（PCT：sensitivity 94%,specificity 90%;hs-CRP：sensitivity 91%,specificity 75%）. Conclusions The combined assessment of serum PCT and hs-CRP can be a biological marker for early diagnosis and prognosis of SAP.