血清PCT与PCT清除率在呼吸机相关性肺炎感染疗效及预后的评估价值

Evaluation value of curative effect and prognosis of serum PCT and PCT clearance in VAP infections

目的探讨血清降钙素原(PCT)、降钙素原清除率(PCT-c)在呼吸机相关性肺炎(VAP)感染患者疗效及预后中的评估价值。方法采用单中心回顾性研究,纳入2015年1月-2016年12月医院ICU住院治疗、符合VAP诊断标准的70例患者。记录患者一般临床资料,患者入院后均给予经验性抗感染治疗,于10d后评估疗效,并分为恶化组和好转组,每组各35例。取确诊VAP时患者第5、7、9天清晨血,检测血清PCT并计算PCTc。比较两组患者不同治疗时间点PCT和PCT-c是否存在差异;ROC分析PCT和PCT-c对VAP感染患者预后的预测效力。结果随着治疗时间的延长,好转组的PCT水平下降,恶化组仍保持较高水平;恶化组确诊第5、7和9天时PCT水平高于好转组(P<0.05);好转组患者PCT-c保持高水平,且随着病情好转而逐渐升高;恶化组PCT-c较低,随着病情进展而逐渐下降;恶化组确诊第5、7和9天时PCT-c低于好转组(P<0.05);ROC分析显示,确诊后第9天PCT和PCT-c对VAP患者预后预测的敏感性和特异性最高。结论 PCT和PCT-c可以较好地预测VAP感染患者的预后,PCT-c的预测效力要优于PCT绝对值。

OBJECTIVE To explore the evaluation value of curative effect and prognosis of serum procalcitonin（PCT）and procalcitonin clearance（PCT-c）in patients with ventilator associated pneumonia（VAP）infections.METHODS A total of 70 patients diagnosed with VAP and treated in intensive care unit（ICU）of our hospital from Jan.2015 to Dec.2016 were enrolled by single-center retrospective study.The general clinical data were recorded in details.All the patients enrolled were treated with empirical anti-infection immediately when the VAP was diagnosed,and according to the curative effect after 10 days,the patients were divided into deteriorating group and improved group,with 35 cases in each group.The early morning blood was collected,and serum PCT level was detected on the fifth,seventh and ninth days after diagnosis,and also the PCT-c was calculated simultaneously.The levels of PCT and PCT-c at different treatment time points between the two groups were compared,and the predictive efficiency of PCT and PCT-c on evaluating the prognosis of VAP infection was analyzed by ROC analysis.RESULTS The level of PCT decreased gradually in improved group with the prolonged time of therapy,while with maintaining high level in deteriorating group.The levels of PCT in the patients of deteriorating group on the fifth,seventh and ninth days were higher than those of improved group（P〈0.05）.The PCTc maintained high levels in the patients of improved group,and increased gradually with improvement of the patients’ condition,while the level of PCT-c decreased in deteriorating group with the progression of the patients’ condition.The levels of PCT-c of deteriorating group on the fifth,seventh and ninth days were obviously lower than those of improved group（P〈0.05）.The PCT and PCT-c on the ninth day after VAP diagnosis demonstrated the highest sensitivity and specificity on evaluating prognosis in patients with VAP infection by ROC analysis.CONCLUSIONPCT and PCT-c can better predict the prognosis of the patients with VAP infection,and the predictive efficiency of PCT-c is better than PCT absolute value.