获得性免疫缺陷综合征细菌性及肺孢子菌肺炎患者炎性指标比较

Comparison of inflammatory markers of bacterial pneumonia and Pneumocystis pneumonia in HIV/AIDS patients

目的寻找鉴别获得性免疫缺陷综合征(AIDS)患者中细菌性肺炎与肺孢子菌肺炎(PCP)特异性较高的炎性指标。方法比较AIDS细菌性肺炎与PCP患者降钙素原(PCT)及C反应蛋白(CRP)等炎性指标的差异,及各指标对诊断价值。结果该研究中,细菌性肺炎组40例,PCP组53例。两组患者的体温比较差异无统计学意义(P>0.05),白细胞(WBC)计数及CRP之间差异亦无统计学意义(P>0.05),但细菌性肺炎组患者的PCT水平高于PCP组,分别为(0.79±1.25)和(0.15±0.10),(P<0.05)。PCT对于AIDS患者细菌性肺炎诊断的受试者工作特征(ROC)曲线下面积(AUC)为0.853,准确性较高,最佳诊断分界点为0.205(敏感性95%,特异性76%),而CRP对AIDS细菌性肺炎诊断AUC为0.563,准确性较低。结论推荐PCT可以用于AIDS患者细菌性肺炎与PCP的鉴别。

Objective To seek a suitable marker for differentiating bacterial pneumonia from Pneumocystis pneumonia （PCP） in HIV/AIDS patients. Methods Inflammatory markers like C-reactive protein （CRP） and procalcitonin （PCT） were compared between HIV/AIDS patients with bacterial pneumonia and those with PCP, and the diagnostic value of each index was analyzed. Results There were 40 AIDS patients with bacterial pneumonia and 53 AIDS patients with PCP in our study. The difference was not significant between the two groups in temperature, white blood cell （WBC） or CRP （P 〉 0.05）. But the PCT level （ng/L） in the bacterial pneumonia group was significantly higher than rthat in the PCP group [（0.79 ± 1.25） vs （0.15 ± 0.10）, P 〈 0.05]. In receiver operator characteristic （ROC） analysis, the area under curve （AUC） of PCT in diagnosing bacterial pneumonia was 0.853, the cut-off point was 0.205 （the sensitivity was 95%, and the specificity of 76%）; while the AUC of CRP in diagnosing bacterial pneumonia was 0.563, the accuracy was low. Conclusions PCT might be a suitable marker for differentiating bacterial pneumonia from PCP in HIV/AIDS patients.