血清降钙素原对急性左心衰竭患者社区获得性肺炎的临床诊断研究

Clinical value of serum PCT in diagnosis of patients with acute left heart failure complicated with community acquired pneumonia

目的探讨血清降钙素原(PCT)对急性左心衰竭并发社区获得性肺炎患者的临床价值。方法从2014年1月-2017年2月到医院就诊的急性左心衰竭的患者中选择106例,其中合并社区获得性肺炎者56例,未合并肺炎者50例,并将其分为研究组和对照组。比较两组患者动态血清PCT、C-反应蛋白(CRP)变化,血清PCT浓度水平与肺炎严重程度、抗菌药物使用时间、住院时间的关系,并将研究组分为细菌感染组29例和非细菌感染组27例,观察两组患者之间血清PCT浓度水平。结果研究组不同时间段血清PCT浓度均比对照组高,差异有统计学意义(P<0.05);以血清PCT>0.05μg/L为阳性标准诊断急性左心衰竭合并社区获得性肺炎的敏感性为91.07%,特异性为88.00%;患者血清PCT浓度水平与患者肺炎严重程度呈正相关,抗菌药物运用时间和住院时间也随血清PCT浓度水平增长而延长;以血清PCT>2.0μg/L为阳性标准诊断急性左心衰竭合并肺部细菌感染的敏感性为75.86%,特异性为70.37%。结论血清PCT在诊断急性左心衰竭合并社区获得性肺炎和判断患者肺炎严重程度中起着重要的作用,并可以估计患者肺部感染的病原体类型。

OBJECTIVE To investigate the clinical value of serum PCT in patients with acute left heart failure complicated with community acquired pneumonia.METHODS A total of 106 patients with acute left heart failure in our hospital from Jan.2014 to Feb.2017 were selected,among them,56 cases were complicated with pneumonia,set as observation group,and 50 cases were without pneumonia,set as control group.The dynamic changes of serum PCT and C-reactive protein（CRP）were compared.The relationship between serum PCT concentration and the severity of pneumonia,antibiotic use time and hospital stay were analyzed.The observation group was divided into bacterial infection group（n=29cases）and non bacterial infection group（n=27cases）,and serum PCT levels were observed between the two groups.RESULTS The concentrations of serum PCT of the study group at different time periods were statistically higher than those of the control group（P〈0.05）.The sensitivity of serum PCT〉0.05ug/L for the diagnosis of acute left heart failure with community acquired pneumonia was 91.07%and the specificity was 88.00%.The level of serum PCT was positively correlated with the severity of lung infection,and antibiotic use time and hospitalization time also increased with the increase of serum PCT concentration.The sensitivity of serum PCT2.0ug/L for the diagnosis of acute left heart failure complicated with pulmonary bacterial infection was 75.86% and the specificity was about 70.37%.CONCLUSIONSerum PCT plays an important role in the diagnosis of acute left heart failure complicated with community acquired pneumonia and in determining the severity of pulmonary infection,and can estimate the types of pathogens in patients with lung infections.