血清降钙素原、白介素-17及内毒素联合检测在诊断老年呼吸道细菌性感染中的价值

Value of combined detection of serum PCT,IL-17 and endotoxin in the diagnosis of elderly patients with respiratory tract bacterial infection

目的分析血清降钙素原(PCT)、白介素-17(IL-17)、内毒素联合检测诊断老年呼吸道细菌性感染的临床价值。方法选择90例老年呼吸道细菌性感染患者作为观察组,选择同期收治非细菌性病毒感染(非特异性肺炎)老年患者40例作为对照组。测定治疗前血清PCT、IL-17、内毒素水平,分析PCT、IL-17、内毒素联合检测对老年呼吸道细菌性感染的诊断价值。结果观察组血清PCT、内毒素、IL-17水平均显著高于对照组(P<0.05);革兰阴性菌(G-)感染组血清PCT、内毒素、IL-17水平均显著高于革兰阳性菌(G+)感染组(P<0.05);重症肺炎组患者血清PCT、内毒素、IL-17水平均显著高于非重症肺炎组(P<0.05);内毒素诊断G-菌阳性老年呼吸道细菌性感染曲线下面积(AUC)为0.876,敏感度、特异度分为95.2%、91.8%,诊断G+菌阳性老年呼吸道细菌性感染AUC、敏感度、特异度分别为0.601、66.3%、85.5%。PCT、内毒素、IL-17联合诊断G-菌阳性、G+菌阳性老年呼吸道细菌性感染综合价值均显著优于单项诊断(P<0.05)。结论 PCT、IL-17、内毒素对鉴别老年呼吸道细菌性感染与非特异性肺炎有较好的临床价值,3项联合诊断老年呼吸道细菌性感染有较高的敏感度与特异度。

Objective To analyze the clinical value of combined detection of serum proealcitonin （PCT）, interleukin -17 （IL-17） and endotoxin in the diagnosis of elderly patients with respiratory tract bacterial infection. Methods Totally 90 elderly patients with respiratory tract bacterial infection were selected as observation group. Another 40 elderly patients with non-bacterial virus infection （non-specific pneumonia） were selected as control group. The levels of serum PCT, IL-17 and endotoxin were determined before treatment. The diagnostic value of combined detection of PCT, IL-17 and endotoxin in elderly patients with respiratory tract bacterial infection was analyzed. Results The levels of serum PCT, endotoxin and IL-17 were significantly higher in the observation group than the control group （ P 〈0.05）, were significantly higher in G- bacteria infection group than G＋ bacteria infection group （ P 〈0.05）, and were significantly higher in severe pneumonia group than non-severe pneumonia group （ P 〈0.05）. The area under the curve （AUC）, sensitivity and specificity of endotoxin in the diagnosisof G- bacteria positive elderly patients with respiratory tract bacterial infection were 0.876, 95.2% and 91.8% respectively, while those for G＋ bacteria positive were 0.601 , 66.3% and 85.5%, respectively. The combined value of PCT, endotoxin and IL-17 in the diagnosis of G- bacteria positive and G＋ bacteria positive elderly patients with respiratory tract bacterial infection was significantly better than single diagnosis （ P 〈0.05）. Conclusion PCT, IL-17 and endotoxin have good clinical value in the identification of geriatric respiratory infection and non specific pneumonia. The combination of three indexes has high sensitivity and specificity in diagnosis of elderly patients with respiratory tract bacterial infection.