降钙素原和内毒素检测在老年下呼吸道感染诊断的价值

Diagnostic value of serum procalcitonin and endotoxin for lower respiratory infection in the elderly

目的观察血清降钙素原和内毒素检测在老年下呼吸道感染病原诊断和疗效判断中的价值。方法选取2013年10月至2015年5月期间在梧州市红十字会医院诊断治疗的老年下呼吸道感染患者120例为研究对象,再选取60例非细菌感染患者为对照组,检测革兰阴性杆菌(G-)感染患者、革兰阳性球菌(G+)感染患者以及对照组的血清降钙素原(PCT)、内毒素(EAA)以及C-反应蛋白(CRP)水平,同时对比G-感染患者治疗前后的PCT、EAA以及CRP水平。结果G-感染组患者的PCT为(2.96±1.43)ng/m L明显高于G+感染组的(0.78±0.11)ng/m L和对照组的(0.25±0.02)ng/m L,G+感染组的PCT明显高于对照组,差异均具有统计学意义(P<0.05);G-感染组的EAA为(0.217 5±0.08)EU/m L,明显高于G+感染组的(0.034 5±0.007)EU/m L和对照组的(0.012 8±0.006)EU/m L,差异有统计学意义(P<0.05),G+感染组的EAA与对照组无明显差异(P>0.05);三组的CRP水平比较均无明显差异(P>0.05)。G-感染组患者治疗前PCT和CRP分别为(2.95±1.36)ng/m L、(57.76±10.25)mg/L,治疗后分别为(0.24±0.13)ng/m L、(4.21±1.54)mg/L,G-感染组患者治疗前后的PCT和CRP比较差异具有统计学意义(P<0.05),EAA比较差异无统计学意义(P>0.05)。PCT区分G+和G-菌感染的敏感性为91.7%,特异度为75.0%;EAA区分G+和G-菌感染的敏感性为83.3%,特异度为90.0%。结论血清降钙素原和内毒素检测在老年下呼吸道感染病原诊断和疗效判断中具有一定的临床价值。

Objective To determine the value of serum procalcitonin（PCT）and endotoxin（EAA）in the diagnosis and efficacy assessment for lower respiratory infection in the elderly. Methods A total of 120 old patients with lower respiratory tract infection treated in our hospital from October 2013 to May 2015 were enrolled in this study. Another 60 elderly individuals with non- bacterial infection who taking physical examination during the period were also recruited as control group. The serum levels of PCT,EAA and C-reactive protein（CRP）were detected,and the results were compared among those with gram-negative and positive,non-bacterial infections,and those with gram-negative bacterial infection before and after treatment. Results The serum PCT levels were significantly higher in those with gram-negative bacterial infection（2.96±1.43 ng/m L）than those with gram-positive infection（0.78±0.11 ng/m L）and non-bacterial infection（0.25±0.02 ng/m L）,and obvious difference was also seen between the 2 latter groups（all P 〈0.05）. The patients with gram-negative bacterial infection had remarkably higher EAA levels than those with gram-positive and non-bacterial infection[（0.217 5±0.08） vs（0.034 5±0.007）and（0.012 8±0.006）EU/m L,P〉0.05）],but there was no difference between the 2 latter groups（P〉0.05）. For CRP levels,there were no difference among those with gram- negative,positive or non- bacterial infection（P〉0.05）. Before treatment,the serum levels of PCT and CRP were（2.95±1.36）ng/m L、（57.76±10.25）mg/L in the patients with gram-negative infection,but the levels decreased to（0.24±0.13）ng/m L and（4.21±1.54）mg/L respectively after treatment（P〉0.05）. No such change was found in the EAA levels（P〉0.05）. The sensitivity of PCT to distinguish gram-negative and positive infections was91.7%,and the specificity was 75.0%. The sensitivity of EAA to the infections was 83.3%,and the specificity was 90.0%.Conclusion Serum PCT and EAA levels are of certain clinical value in the diagnosis and efficacy assessment for lower respiratory tract infection in the elderly.