降钙素原与C反应蛋白对危重症患者呼吸机相关性肺炎的预后评估

Prognostic value of procalcitonin and C reactive protein in critically ill patients with ventilator-associated pneumonia

目的探讨降钙素原(PCT)与C反应蛋白(CRP)对危重症患者呼吸机相关性肺炎的预后评估。方法选取确诊为呼吸机相关性肺炎(VAP)的患者61例,于确诊当日及确诊后第4、8天检查患者血清PCT及CRP水平。按预后分为存活组和死亡组,其中存活组39例,死亡组22例。比较两组VAP患者于确诊后第0、4、8天的PCT和CRP水平及分析在不同时间段PCT截断值与死亡预后的关系。结果两组VAP患者确诊当天的血清PCT和CRP水平比较差异均未见统计学意义(P>0.05);与存活组相比,死亡组患者于确诊第4天和第8天的血清PCT较高,差异有统计学意义(P<0.05);且存活组患者于确诊第0、4、8天的血清PCT水平呈下降趋势;两组VAP患者的血清CRP水平于确诊第0、4、8天比较差异均未见统计学意义(P>0.05);确诊第4天PCT水平>1μg/L是最强的死亡预兆。结论血清PCT水平是危重症患者呼吸机相关肺炎的重要预测标志物,未发现CRP水平与该疾病的预后存在相关性;确诊第4天PCT水平是预测危重症患者呼吸机相关肺炎病死率的关键指标。

Objective To investigate the prognostic value of procalcitonin and C reactive protein in severe patients with ventilator-associated pneumonia. Methods Sixty one patients with ventilator-associated pneumonia were selected. The serum PCT and CRP levels were examined on the day of diagnosis and on 4 th and 8 th day after diagnosis. According to the prognosis,they were divided into survival group（ n = 39） and death group（ n = 22）. The levels of PCT and CRP were compared and the relationship between PCT cutoff values and death prognosis at different time intervals were analyzed.Results There was no significant difference in serum PCT or CRP levels between the two groups on the day of diagnosis（ P〉0. 05）. Compared with the survival group,the serum PCT levels in the death group was significantly higher on the 4 th day and the 8 th day,the differences were significant（ P〈0. 05）,and the level of serum PCT in the survival group had a dounward trend at 0,4 th and 8 th days after diagnosed. There was no significant difference in serum CRP level at 0,4 th and 8 th days after diagnosis（ P〉0. 05）. PCT levels above 1 μg/L on the 4 th day after the diagnosis was the strongest predictor of mortality. Conclusions Serum PCT level is an important predictor of ventilator-associated pneumonia in severe patients. No relationship was found between the level of CRP and the disease. Fourth days after driagnosis,PTC level is a key index for predicting the mortality of ventilator-associatied pneumonia in critically in patients.