血清降钙素原水平测定对老年患者下呼吸道感染的诊断价值

Significance of serum procalcitonin levels in diagnosis of lower respiratory tract infections in elderly patients

目的探讨血清降钙素原(PCT)水平测定对老年患者下呼吸道感染的诊断意义,从而对患者进行全面的评估。方法选择2011年1月-2015年6月医院收治的老年下呼吸道感染患者102例为研究对象,按感染类型将其分为两组,68例细菌性感染患者为观察组,34例非细菌性感染患者为对照组,分析两组患者的PCT和C-反应蛋白(CRP)水平,两组患者在PCT和CRP的灵敏度、特异度比较,观察组不同时间的PCT和APACHEⅡ评分。结果观察组患者PCT和CRP的水平分别为(7.2±2.6)μg/L和(11.2±3.5)mg/L,均明显高于对照组的(3.8±1.3)μg/L和(8.7±2.9)mg/L,差异均有统计学意义(P<0.05);观察组中PCT的敏感度和特异度分别为98.5%和91.2%,均高于对照组的79.4%和64.7%,两组差异有统计学意义(P<0.05),而观察组中CRP的敏感度相对较高,但是与对照组间差异无统计学意义,且特异度较低,与对照组相比差异有统计学意义(P<0.05);随着对患者的治疗,PCT的水平得到下降,使患者的APACHEⅡ评分下降,且第1天和第8天的PCT水平及APACHEⅡ评分差异有统计学意义(P<0.05)。结论老年患者下呼吸道细菌性感染的病情可通过PCT水平的测定对病情的严重程度及预后进行全面的评估,是一个较好的诊断指标。

OBJECTIVE To discuss the diagnostic value of serum procalcitonin（PCT）levels for lower respiratory tract infections in elderly patients so as to make an overall evaluation of patients.METHODS Totally 102 cases of elderly patients with lower respiratory tract infections during Jan.2011 to Jun.2015 were selected and were divided into two groups by infection types,i.e.,the observation group of 68 cases of bacterial infections and the control group of 34 cases of non-bacterial infection.The two groups of patients were analyzed for serum procalcitonin（PCT）and C-reactive protein（CRP）level and compared for PCT and CRP sensitivity.Serum procalcitonin levels and APACHEⅡ score at different time points were observed in the observation group.RESULTS PCT and CRP levels were（7.2±2.6）μg/L and（11.2±3.5）mg/L in the observation group,significantly higher than（3.8±1.3）μg/L and（8.7±2.9）mg/L in the control group（P〈0.05）.PCT sensitivity and specificity was 98.5%and 91.2% in the observation group,significantly higher than 79.4% and 64.7% in the control group（P〈0.05）.The CRP had higher sensitivity for diagnosis in the observation group,but with no significant difference compared to the control group.And CRP had low specificity for diagnosis in the observation group,with a significant difference compared with the control group（P〈0.05）.Along with the treatment of the patients,the levels of PCT dropped,thus decreasing APACHEⅡ scores of the patients,and the difference in PCT levels and APACHEⅡ score at 1day and 8days were significant（P〈0.05）.CONCLUSIONDisease severity and prognosis of elderly patients with bacterial infections of lower respiratory tract can be determined by measuring PCT level which is a good diagnostic indicator.