高血压脑出血合并肺部细菌感染患者PCT、CRP、和肽素水平变化对预后影响研究

Influence of changes of PCT,CRP,and peptide levels on prognosis of hypertensive cerebral hemorrhage patients complicated with pulmonary bacterial infections

目的探讨高血压脑出血合并肺部细菌感染患者降钙素原(PCT)、C-反应蛋白(CRP)、和肽素水平变化对预后影响,以期为临床治疗提供数据依据。方法选取医院2012年1月-2015年1月收治高血压脑出血合并肺部感染患者68例为A组,同期住院未合并肺部感染高血压脑出血患者68例为B组,同期健康体检者68例为C组;B组入院后给予常规保守治疗,A组在B组基础上给予抗菌药物治疗,观察三组治疗前及治疗7d后PCT、CRP、和肽素、白细胞计数(WBC)及中性粒细胞比例(N)水平变化,同时观察A、B组治疗前后各指标阳性率。结果 A组治疗前各项指标高于同组治疗后及其他两组治疗前后(P<0.05),B组治疗后PCT、CRP、和肽素低于同组治疗前(P<0.05),高于C组(P<0.05);以PCT>0.5ng/L、CRP>10mg/L、和肽素>0.01ng/ml、WBC>10×109/L、N%>70%定为阳性;A组治疗后PCT、CRP及和肽素阳性率低于治疗前(P<0.05),高于B组同期(P<0.05);A组感染发生30d内,共死亡23例,病死率33.82%;生存患者PCT、CRP及和肽素均低于死亡患者(P<0.05)。结论 PCT、CRP及和肽素联合监测可作为高血压脑出血合并肺部感染预测指标,指导临床治疗,且可作为预后预测指标。

OBJECTIVE To explore the influence of changes of procalcitonin（PCT）,C-reactive protein（CRP）,and peptide levels on prognosis of hypertensive cerebral hemorrhage patients complicated with pulmonary bacterial infections so as to provide guidance for clinical treatment.METHODS Totally 68 hypertensive cerebral hemorrhage patients complicated with pulmonary infections who were treated in the hospital from Jan 2012 to Jan 2015 were assigned as the group A,meanwhile,68 hypertensive cerebral hemorrhage patients without pulmonary infections were set as the group B,and 68 healthy people who received physical examination were assigned as the group C.The group B was given conventional conservative therapy,the group A was treated with antibiotics based on the treatment of the group B.The levels of PCT,CRP,and peptide as well as white blood cell（WBC）counts were observed and compared among the three groups before the treatment and after the treatment for 7days;the positive rates of the indicators were observed and compared between the group A and the group B before and after the treatment.RESULTS The levels of the indicators of the group A were higher before the treatment than after the treatment and were higher than those of other two groups before and after the treatment（P〈0.05）.The levels of PCT,CRP,and peptide of the group B were lower after the treatment than before the treatment and were higher than those of the group C（P〈0.05）.The PCT more than 0.5ng/L,CRP more than 10mg/L,peptide more than0.01ng/ml,WBC more than 10×109/L,and N% more than 70% were defined as the positive;the positive rates of PCT,CRP,and peptide of the group A were lower after the treatment than before the treatment and were higher than those of the group B（P〈0.05）.Totally 23 patients with infections in the group A died within 30 days,with the mortality rate 33.82%;the levels of PCT,CRP,and peptide of the patients who survived were lower than those of the patients who died（P〈0.05）.CONCLUSION The PCT,CRP,and peptide can be used as the predictive indicators for the complicated pulmonary infections in the hypertensive cerebral hemorrhage patients and provide guidance for clinical treatment,which can be used as the indicators for prediction of the prognosis.