降钙素原对社区获得性肺炎死亡率及病情评估的价值

Value of procalcitonin in predicting mortality and severity of community-acquired pneumonia

目的探索降钙素原(PCT)对社区获得性肺炎(CAP)患者的死亡率和病情评估的价值。方法前瞻性研究在急诊科通过症状和X线检查诊断为CAP的114例患者,收集患者的一般临床资料及炎症标志物。采用肺炎严重性指数(PSI)、CURB65评分评估CAP患者的疾病严重性,分析血沉(ESR)、白细胞计数、高敏C反应蛋白(Hs-CRP)及PCT预测CAP患者死亡率和疾病严重性的价值。结果 114例患者中14例高危患者28天内死亡。死亡组较存活组PCT和Hs-CRP水平显著增高(2.96±1.54比0.38±0.24 ng/m L,P<0.05)(194.61±72.80比101.26±65.98 mg/L),依据PSI和CURB65评分系统对疾病严重性的评估结果,病情严重患者PCT水平显著升高。逻辑回归分析表明,PCT水平预测CAP死亡率ROC曲线下面积为0.81,PCT水平结合PSI和CURB65评分来预测CAP患者的疾病严重性,ROC曲线下面积显著增加。结论 PCT水平能很好预测急诊CAP患者的死亡率和病情的严重性,PCT水平结合PSI和CURB65评分,更有利于评估预后和病情严重性。

Objective To study the value of procalcitonin （PCT） level in predicting mortality and severity of community-acquired pneumonia （CAP） in the emergency department. Methods The general clinical data and in-flammatory biomarker of 114 patients with CAP were collected. The severity of CAP was assessed by PSI and CURB65 score. An analysis was performed to assess the value of PCT, WBC counts, high-sensitivity C-reactive pro-tein （hs-CRP）, and erythrocyte sedimentation rate （ESR） for the prediction of mortality and severity. Results 14 high-risk patients died within 28 days. Compared with the survival group, the death group had significantly increased PCT level （2. 96 ± 1. 54 vs 0. 38 ± 0. 24 ng/ mL, P 〈 0. 01） and hs-CRP（194. 61 ± 72. 80 vs 101. 26 ± 65. 98 mg/ L,＂nbsp;P 〈 0. 01）. The PCT level was significantly higher in the severe group than in the moderate group according to PSI and CURB65 score. Through logistic regression analyses, the area under the receiver operating characteristic curve （ROC） of PCT level were 0. 81. The area under ROC increased significantly while it used PCT combined with PSI and CURB65 score to predict the mortality and severity of CAP. Conclusion The level of PCT is a more versatile tool for predicting mortality and severity of CAP in the emergence department, and the level of procalcitonin as an ad-junct to CAP prediction rules may be valuable for prognosis and severity assessment.