动态监测降钙素原及前白蛋白对于儿童重症细菌性肺炎的临床意义

Clinical significance of dynamic monitoring of procalcitonin and prealbumin in children with severe bacterial pneumonia

目的探讨动态监测降钙素原(PCT)及前白蛋白(PA)在儿童重症细菌性肺炎诊治中的应用价值。方法回顾性选取100例细菌性肺炎患儿,依照病情严重程度分为重症肺炎组(重症细菌性肺炎患儿,n=50)与普通肺炎组(轻、中症细菌性肺炎患儿,n=50)。普通肺炎组患儿结合痰培养结果予抗生素及支持对症治疗,重症肺炎组患儿联合吸氧、机械通气、无创呼吸机及生物制剂治疗。比较两组入院第1天、第2天、第3天的PCT、PA、CRP、IL-6水平及其72h变化率。计算两组总有效率,比较两组中有效患者与无效患者的PAT与PA的72 h变化率。结果重症肺炎组入院第1天、第2天、第3天的PCT水平显著高于普通肺炎组(P<0.05)。重症肺炎组PCT的72 h变化率为(0.26±0.08)%,显著低于普通肺炎组(0.42±0.10)%(P<0.05)。重症肺炎组入院第1天、第2天、第3天的PA水平显著低于普通肺炎组(P<0.05)。重症肺炎组PCT的72 h变化率为(-0.32±0.07)%,显著低于普通肺炎组(-0.38±0.11)%(P<0.05)。重症肺炎组入院第1天、第2天、第3天的CRP水平与IL-6水平均显著高于普通肺炎组(P<0.05)。两组CRP、IL-6的72 h变化率差异无统计学意义(P>0.05)。重症肺炎组总有效率76.00%,显著低于普通肺炎组的92.00%(P<0.05)。重症肺炎组与普通肺炎组中有效患者的PAT及PA的72 h变化率均显著高于无效患者(P<0.05)。PCT水平与CPIS评分、APACHE评分均呈显著正相关(P<0.05);PA水平与CPIS评分、APACHE评分呈显著负相关(P<0.05)。结论动态监测PCT及PA可有效评估儿童重症细菌性肺炎病情与预测预后,同时PA的检测费用低,可取代PCT成为儿童重症细菌性肺炎更经济的监测指标。

Objective To explore the value of dynamic monitoring of procalcitonin and prealbumin in children with severe bacterial pneumonia. Methods A total of 100 children with bacterial pneumonia were selected and divided into severe pneumonia group（ severe bacterial pneumonia,n = 50） and common pneumonia group（ light,moderate bacterial pneumonia according to severity of illness,n = 50） according to the severity of illness. Patients with common pneumonia were treated with antibiotics and symptomatic treatment according to the sputum culture results.Children with severe pneumonia were treated with oxygen inhalation,mechanical ventilation,non-invasive ventilator and biological agents. The levels of PCT,PA,CRP,IL-6 and the 72 h change rate of them were compared between the two groups on the 1 st,2 nd,and 3 rd days of admission. The total effective rate of two groups were calculated and the 72 h change rate of PAT and PA between effective patients and ineffective patients were compared in the two groups. Results The PCT levels in the severe pneumonia group on the 1 st,2 nd,and 3 rd days of admission were significantly higher than those in the common pneumonia group（ P〈0. 05）. The 72 h change rate of PCT in the severe pneumonia group was（ 0. 26 ± 0. 08） %,which was significantly lower than in the comm that in pneumonia group（ 0. 42 ± 0. 10） %（ P〈0. 05）. The levels of PA in the severe pneumonia group on the 1 st,2 nd,and 3 rd days of admission were significantly lower than those in the common pneumonia group（ P〈0. 05）. The 72 h change rate of PA in the severe pneumonia group was（-0. 32 ± 0. 07） %,which was significantly lower than that in the common pneumonia group（-0. 38 ± 0. 11） %（ P〈0. 05）. In the severe pneumonia group,the levels of CRP and IL-6 were significantly higher on the 1 st,2 nd,and 3 rd days of admission than in the pneumonia group（ P〉0. 05）. There was no significant difference in the 72 h change rate of CRP and IL-6 between the two groups（ P〉0. 05）. The total effective rate was 76. 00% in the severe pneumonia group,which was significantly lower than that in the common pneumonia group 92. 00%（ P〈0. 05）. The 72-hour change rate of PAT and PA in effective pneumonia patients of the severe pneumonia group and common pneumonia group were significantly higher than those in ineffective patients（ P〈0. 05）. There was a significant positive correlation between PCT levels and CPIS scores and APACHE scores（ P〈0. 05）. PA levels were significantly negatively correlated with CPIS scores and APACHE scores（ P〈0. 05）. Conclusion Dynamic monitoring of PCT and PA can effectively assess the condition of severe bacterial pneumonia in children and predict the prognosis. At the same time,the detection cost of PA is low,which can replace PCT as a more economical monitoring indicator of severe bacterial pneumonia in children.