降钙素原对呼吸机相关性肺炎老年重症患者预后评估价值

Prognosis predicting value of PCT levels in elderly critical patients with ventilator associated pneumonia

目的观察老年重症呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)患者血液中的降钙素原(Procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、白细胞计数(White blood cell count,WBC)水平的动态变化,探讨其对VAP患者预后评估价值。方法收集2014年1月~2016年12月我院综合ICU发生VAP感染的73例老年患者资料,根据28d后病情变化分为死亡组和存活组,观察诊断VAP当天、治疗后第3天、治疗后第7天PCT、CRP、WBC的水平变化并分析。结果老年重症VAP患者以革兰阴性菌感染为主,诊断VAP当天两组患者体内WBC、PCT、CRP水平无明显差异。诊断VAP后第3天和第7天,两组患者体内的CRP水平无明显差异(P>0.05),PCT水平差异存在统计学意义(P<0.05)。在诊断VAP第7天患者体内PCT水平联合APACHEⅡ评分预测预后能力最好。结论 PCT水平可作为预测老年重症VAP患者预后的生物学标志物,PCT在VAP诊断后第7天的预测预后能力最强。PCT联合APACHEⅡ评分能够增强对老年重症VAP患者预后的预测能力。

Objective To assess the prognostic value of procalcitonin（PCT）,C-reactive protein（CRP）and white blood cell count（WBC）in elderly critical patients with ventilator associated pneumonia（VAP）. Methods Collected the data of 73 elderly critical patients with VAP in ICU from Jan 2014 to Dec 2016. All patients were divided into survival group and non-survival group according to the conditions at the 28 d after VAP diagnosis.Blood samples PCT,CRP and WBC were collected and assessed at the day of the VAP diagnosis, and the 3 th and 7 th day after the diagnosis. Results Elderly patients with severe VAP were mainly infected with gram-negative bacteria, there was no significant difference in WBC, PCT and CRP level between the two groups. There was no significant difference in CRP level and statistically significant between the two groups at the 3 th and 7 th day after the diagnosis of VAP. PCT level combined with APACHEⅡ score was the best predictor of prognosis in patients with VAP at the 7 th day after diagnosis. Conclusion PCT can be used as a biomarker for predicting the prognosis of elderly patients with severe VAP, PCT had the strongest prognostic ability at 7 th day after the VAP diagnosis. Combined with APACHEⅡ score, PCT can enhance the predictive ability of elderly patients with severe VAP.