重症肺炎患者血清降钙素原、乳酸水平和乳酸清除率的变化及临床意义

Changes of serum procalcitonin, lactate and lactic acid clearance in severe pneumonia and its clinical significance

目的 探讨重症肺炎患者血清降钙素原（PCT）、乳酸水平及乳酸清除率的变化及临床意义.方法 选取70例重症肺炎的患者,其中医院获得性肺炎16例,社区获得性肺炎54例.所有患者在治疗第1、4、7天以及转科或死亡前抽取清晨静脉血,检测PCT、动脉血乳酸（Lac）、计算24 h乳酸清除率（Lcr）.根据患者转归情况,分为生存组及死亡组,观察两组患者不同时间PCT及Lac水平.根据入院24 h Lcr将患者分为高Lcr组及低Lcr组,观察两组患者初始Lac及病死率.结果 所有患者中死亡25例,生存45例.两组治疗第1天PCT及Lac水平差异无统计学意义（F=0.87,P=0.19;F=0.03,P=0.40）.存活组随着治疗进展,于第4、7天及转科前血清内的PCT值[（19.5±11.1）ng/L,（7.9±3.2）ng/L,（3.6±1.4）ng/L]、Lac值[（2.8±1.6）mmol/L,（2.2±1.1）mmol/L,（1.7±0.8）mmol/L]均出现不同程度的下降,显著低于同时间段死亡组PCT[（39.6±24.8）ng/L,（40.4±21.9）ng/L,（41.6±38.3）ng/L],Lac[（6.8±3.2）mmol/L,（6.2±2.1）mmol/L,（7.7±2.8）mmol/L]（F=3.84,P=0.003;F=7.38,P=0.00;F=4.95,P=0.00;F=5.86,P=0.00;F=6.05,P=0.00;F=10.48,P=0.00）;而死亡组血清PCT值、Lac值随着治疗未见明显下降趋势,在病程第4、7天及死亡前一直处于较高状态,甚至高于治疗第1天.高Lcr组病死率15.79％,低于低Lcr组的59.38％（χ2=14.37,P=0.00）;两组初始初始Lac、PCT差异无统计学意义（t=0.17,P=0.43;t=0.41,P=0.34）.结论 联合检测重症肺炎患者血清中的PCT和Lac的水平并进行动态观察对于判断患者病情的轻重,早期Lcr可对患者预后评估具有积极的意义.

Objective To investigate the changes of serum procalcitonin （ PCT ） , lactate and lactic acid clearance in severe pneumonia and its clinical significance .Methods Seventy patients with severe pneumonia were enrolled,including 16 cases with hospitalized pneumonia and 54 cases with community acquired pneumonia .All patients were exsanguinated early morning venous blood on day 1,4,7 after treatment,and transferred-out or before death.PCT and arterial lactic acid were measured and 24 -hour lactate clearance was calculated .According to the outcome , the patients were divided into survival group and death group .At different time points , the PCT and Lac levels were observed in the two groups .The patients were divided into high lactic acid clearance group and low lactic acid clearance group according to the 24h lactic acid clearance rate .The initial Lac and mortality were observed . Results All patients had 25 cases of deaths and 45 cases of survive.There were no statistically significant differences in PCT and Lac levels at the 1st day of treatment between the two groups （F=0.87,P=0.19;F=0.03,P=0.40）. The PCT levels[（19.5 ±11.1）ng/L,（7.9 ±3.2）ng/L,（3.6 ±1.4）ng/L]and Lac values[（2.8 ±1.6）mmol/L, （2.2 ±1.1）mmol/L,（1.7 ±0.8）mmol/L]at the 4th,7th day of treatment and transferred -out in the survival group were significantly lower than those in the death group [PCT：（39.6 ±24.8） ng/L,（40.4 ±21.9） ng/L,（41.6 ± 38.3）ng/L,Lac：（6.8 ±3.2）mmol/L,（6.2 ±2.1）mmol/L,（7.7 ±2.8）mmol/L,F=3.84,P=0.003;F=7.38, P=0.00;F=4.95,P=0.00;F=5.86,P=0.00;F=6.05,P=0.00;F=10.48,P=0.00].In death group,the serum PCT value and lactic acid value were not significantly decreased with the treatment , and remained in the higher state at the 4th,7th day of treatment and before death ,and even higher than the first day of treatment .The mortality of the high lactic acid clearance group was 15.79％,which was significantly lower than 59.38％ in the low lactic acid clearance group （χ2 =14.37,P=0.00）.The initial Lac and PCT of the two groups had no statistically significant differences （ t =0.17, P =0.43;t =0.41, P =0.34 ）.Conclusion For the patients with severe pneumonia ,the detection of serum PCT and lactic acid levels and dynamic observation is helpful to judge the severity of the disease.The early lactic acid clearance rate may be of positive significance to the prognosis of patients .