动态检测血清降钙素原与超敏C-反应蛋白在老年社区获得性肺炎抗生素应用中的价值

Value of dynamic detection of serum calcitonin and high sensitive C-reactive protein in guiding the application of antibiotics in elderly patients with community acquired pneumonia

目的探讨血清降钙素原(PCT)联合超敏C-反应蛋白(hs-CRP)的动态检测,在老年社区获得性肺炎(CAP)抗生素应用中的指导意义。方法选取2012年1月至2015年10月我科收治的老年CAP病人80例,按照计算机生成数字,随机分为2组,其中观察组40例,治疗前及治疗第3、5、7天动态检测PCT和hs-CRP水平,并根据结果指导抗生素的应用;对照组40例,根据CAP指南进行抗感染治疗。观察2组病人抗生素应用、住院情况及PCT、hs-CRP水平的变化,并分析诊断CAP的灵敏度及特异度。结果观察组病人抗生素使用率为72.5%,与对照组的95.0%相比,差异有统计学意义(P<0.05);观察组抗生素使用时间为(7.2±1.5)d,短于对照组的(11.7±1.8)d(P<0.01)。与对照组比较,观察组联合用药率也明显减少(17.5%比40.0%,P<0.05),住院时间缩短[(10.4±3.1)d比(14.9±4.4)d](P<0.05),但2组病人的临床治疗有效率差异无统计学意义(P>0.05)。观察组病人使用抗生素治疗后,第3、5、7天PCT水平均显著下降,hs-CRP在第5、7天较入院时显著下降,差异具有统计学意义(P<0.05),且观察组下降幅度大于对照组,差异具有统计学意义(P<0.05);PCT对于老年CAP的诊断敏感性为86.90%,特异性为64.98%,hs-CRP敏感性为76.71%,特异性为47.69%,联合检测对老年CAP的诊断敏感性、特异性较单项测定高。结论动态检测血清PCT、hs-CRP对老年CAP的抗生素应用具有一定的指导作用,值得临床推广。

Objective To investigate the significance of dynamic detection of serum calcitonin（ PCT） and high sensitive C-reactive protein（ hs-CRP） in guiding the application of antibiotics in elderly patients with community acquired pneumonia（ CAP）. Methods Eighty elderly CAP patients from January 2012 to October 2015 admitted to our hospital,in accordance with the digital computer generated,were randomly divided into observation group and control group with 40 cases in each group.The observation group received the treatment according to dynamic detection of PCT and hs-CRP,and the control group received anti-infection treatment according to CAP guidelines. The antibiotic use,hospitalization,PCT,hs-CRP levels,sensitivity and specificity of the two groups were observed.Results In the observation group, the antibiotic use rate was 72. 5%, antibiotic use time and hospitalization time were 7. 2 ± 1. 5 d and 10. 4 ± 3. 1 d,compared with 95. 0%,（ 11. 7 ± 1. 8） d and（ 14. 9±4. 4） d（ P〈0. 05 or 〈0. 01） in the control group. But the clinical efficiency of two groups was90. 14% and 89. 50% respectively,with no significant difference（ P〉0. 05）. The level of PCT 3,5,7 d and the level of hs-CRP 5,7 d after treatment were significantly decreased in the observation group（ P〈0. 05）. The diagnosis sensitivity of PCT was 86. 90%,the specificity being 64. 98%; the sensitivity of hs-CRP was 76. 71%,the specificity being 47. 69%; the sensitivity and specificity of combined detection of PCT and hs-CRP were 96. 28% and 75. 22%,which were statistically increased（ P〈0. 05）. Conclusions The dynamic detection of serum PCT and hs-CRP has a certain guiding role in the application of antibiotics in the elderly CAP. It is worthy to be popularized in clinical practice.