不同炎性指标评估重症肺炎患者病情变化的临床对比研究

Contrastive study of different inflammatory indicators for assessing condition change in patients with severe pneumonia

目的探讨降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素(IL)-6等炎性指标评估重症肺炎患者病情和预后转归价值,以期提高临床诊治水平。方法选取2011年12月至2013年12月74例重症肺炎患者作为观察组,根据肺炎严重指数(PSI)、CURB-65评分和重症肺炎判断标准进行分组,并选择同期非重症肺炎74例作为对照组,观察在以上指标变化情况。结果 PSI危险程度上,低危组在PCT、CRP、IL-6水平上均显著低于中、高危组,差异有统计学意义(P<0.05);CURB-65评分Ⅱ~Ⅲ级在PCT、CRP、IL-6水平上均显著高于CURB-65评分Ⅰ级,差异均有统计学意义(P<0.05);对照组在PCT、CRP、IL-6水平上均显著低于观察组,差异均有统计学意义(P<0.05);存活组随着时间推移其PCT、CRP、IL-6水平逐渐下降,而死亡组则随着时间推移PCT、CRP逐渐升高,IL-6虽然下降,但下降幅度较存活组低,以上指标中,同指标、同时间点比较差异有统计学意义(P<0.05),APACHEⅡ评分存活组显著低于死亡组,差异有统计学意义(P<0.05)。结论 PCT、CRP、IL-6随病情严重而水平不断升高,在一定程度上均能反映重症肺炎病情严重程度和转归。

Objective To investigate the value of procalcitonin（PCT）,C-reactive protein（CRP）and interleukin（IL）-6inflammatory indicators for assessing the disease condition,prognosis and outcome in the patients with severe pneumonia in order to improve the level of clinical diagnosis and treatment.Methods Seventy-four patients with severe pneumonia from December 2011 to December 2013 were selected as the observation group and grouped according to PSI,CURB-65 score and severe pneumonia criteria.Contemporaneous 74 cases of non-severe pneumonia were selected as the control group.The change situation of above indicators were observed.Results In the PSI risk degree,the PCT,CRP and IL-6levels in the low-risk group were significantly lower than those in the middle-risk and high-risk group,the difference was statistically significant（P〈0.05）;the grade Ⅱ-Ⅲ of CURB-65 score in PCT,CRP and IL-6levels were significantly higher than the grade Ⅰof CURB-65 score,the difference between these two groups was statistically significant（P〈0.05）;the PCT,CRP and IL-6levels in the control group were significantly lower than those in the observation group,the difference was statistically significant（P〈0.05）;the PCT,CRP and IL-6levels in the survival group were gradually decreased with the time elapse,while the PCT and CRP levels in the death group were gradually increased,although the IL-6level was decreased,but the descent degree was lower than that in the survival group,the above indicators had statistical difference in the same indicator and same time（P〈0.05）,the APACHEⅡscore in the survival group was significantly lower than that in the death group,the difference was statistically significant（P〈0.05）.Conclusion The levels of PCT,CRP and IL-6are gradually increased with the disease condition is aggravated and can reflect the severity and outcome of sever pneumonia to a certain extent.