血清降钙素原与肾上腺髓质素前体中段肽在婴幼儿细菌性肺炎诊疗中的临床研究

Clinical research of serum procalcitonin and MR-pro-adrenomedullin in the diagnosis and treatment of bacterial pneumonia in infants

目的:探讨血清降钙素原(PCT)与肾上腺髓质素前体中段肽(MR-pro ADM)在婴幼儿细菌性肺炎中的应用价值,为临床诊疗提供帮助。方法:选取108例出院确诊为细菌性肺炎的患儿,根据入院时感染的严重程度分为局限性感染组42例、脓毒症组31例、严重脓毒症组28例、脓毒性休克组7例;选取同期病毒性肺炎患儿89例设为病毒感染组;将同期体检正常的儿童88例设为健康对照组。比较各组婴幼儿PCT与MR-pro ADM水平,分析PCT与MR-pro ADM在细菌性肺炎中的诊断价值及联合应用后诊断性能的变化;通过Pearson相关分析论证PCT、MR-pro ADM与PCIS评分的相关性;对细菌感染不同程度组PCT与MR-pro ADM诊断指标价值进行分析,计算二者联合应用后的后验概率;观测患儿应用3 d抗生素治疗后PCT、MR-pro ADM水平的变化;评估PCT与MR-pro ADM在严重脓毒症与脓毒性休克中死亡率的预测价值。结果:细菌感染组PCT、MR-pro ADM均显著高于病毒感染组与健康对照组(P<0.05);联合应用PCT与MR-pro ADM检测后,细菌性肺炎诊断的敏感度增至98.71%,特异性增至99.30%,诊断符合率增至99.62%;通过Pearson相关分析,PCT、MR-pro ADM与PCIS评分均呈负相关;细菌感染不同程度组PCT与MR-pro ADM联合应用后验概率均明显升高;经3 d抗生素治疗后,局限性感染组、脓毒症组PCT水平显著下降(P<0.05),严重脓毒症组、脓毒性休克组MR-pro ADM水平显著下降(P<0.05);在严重脓毒症与脓毒性休克的死亡率预测中,MR-pro ADM变化差异显著(P<0.05),PCT变化无统计学意义。结论:PCT与MR-pro ADM在婴幼儿细菌性肺炎的诊疗中具有很高的临床价值,二者联合应用,更为患儿的临床诊断、病情预估、疗效监测及风险预警提供有力的指导。

Objective：To explore the application value of serum procalcitonin （PCT） and MR-pro-Adrenomedullin （MR-proADM） in infants with bacterial pneumonia to provide guidance for clinical diagnosis and treatment. Methods：One hundred and eight children with defined diagnosis of bacterial pneumonia hospitalized were enrolled. According to the severity of infection, the infants with bacterial pneumonia were divided into localized infection group with 42 cases, sepsis group with 31 cases, severe sepsis group with 28 cases and septic shock group with 7 cases. Meanwhile, 89 infants with viral infections were chosen as the viral infection group, and 88 normal children in physical check-up were set as the healthy control group; The levels of PCT and MR-proADM in each group after admission were compared. The diagnostic value of PCT and MR-proADM and the changes of diagnostic performance index after combined application were analyzed. The correlation of PCT, MR-proADM and PCIS score by Pearson correlation analysis was proved. And to analyze the diagnostic value of PCT and MR-proADM in different groups, the Post-test probability were calculated after the combined application .The changes of PCT and MR-proADM levels after 3 days of antibiotic treatment were observed. The predictive values of mortality of PCT and MR-proADM in the severe sepsis group and septic shock group were compared. Results：The levels of PCT and MR-proADM in the infection group were significantly higher than those in the viral infection group and the healthy control group （P〈0.05）. The combined application of PCT and MR-proADM increased the sensitivity of bacterial pneumonia by 98.71%, the specificity by 99.30%, and the diagnostic coincidence rate by 99.62%; According to the Pearson correlation analysis, PCT, MR-proADM and PCIS scores were negatively correlated. The Post-test probabilities of combined application of PCT and MR-proADM in bacterial infection group were significantly increased; While after three days of anti-infection therapy, the levels of PCT in the localized infections group and sepsis group were significantly decreased（P 〈0.05）, the levels of MR-proADM in the severe sepsis group and septic shock group were significantly decreased（P 〈0.05）. Based on the prediction of the mortality of severe sepsis and septic shock, the difference of MR-proADM was significant, but the PCT changes were not statistically significant. Conclusion：PCT and MR-proADM have high clinical value in the application of bcterial pneumonia in infants. And the PCT combined with MR-proADM can provide a strong guidance for the clinical diagnosis, condition prediction, curative monitoring and risk prediction for children.