PCT及IL-1β对重型脑外伤患者发生医院获得性肺炎的诊断价值

Diagnostic value of PCT and IL-1β for hospital acquired pneumonia in patients with severe traumatic brain injury

目的探讨血清降钙素原(procalcitonin,PCT)及白细胞介素-1β(interleukin-1β,IL-1β)对重型脑外伤患者发生医院获得性肺炎(HAP)的诊断价值。方法选取2015年3月-2018年3月海南省第三人民医院收治的重型脑外伤患者138例,根据其是否发生医院获得性肺炎分为HAP组(57例)和非HAP组(81例),比较两组入院1 d、3 d、7 d时的血清PCT及IL-1水平变化。应用受试者工作特征(ROC)曲线分析各时间点血清PCT及IL-1β水平对HAP的诊断价值。结果 HAP组第3天、第7天血清PCT及IL-1β水平明显高于非HAP组(P均<0.05)。HAP组血清PCT及IL-1β水平明显随时间升高(P均<0.05)。ROC曲线显示,第3天PCT及IL-1β联合诊断重型脑外伤HAP的AUC(95%CI)为0.908(0.847~0.969),明显高于单项第3天PCT[0.824(0.765~0.884)]及IL-1β[0.817(0.756~0.872)],其敏感度和特异度为91.2%和86.0%。结论第3天PCT及IL-1β联合检测有助于诊断重型脑外伤患者医院获得性肺炎。

Objective To investigate the diagnostic value of serum procalcitonin（PCT） and interleukin-1β（IL-1β） in severe traumatic brain injury patients with hospital acquired pneumonia（HAP）. Methods From March 2015 to March 2018, 138 patients with severe traumatic brain injury admitted to the Third People＇s Hospital of Hainan province were selected. They were divided into HAP group（n=57） and non-HAP group（n=81） according to whether they had hospital acquired pneumonia or not. The changes of serum PCT and IL-1β levels in two groups at day 1, day 3, day 7 after admission were compared. The predictive value of serum PCT and IL-1β levels in each time point for HAP was analyzed using ROC curve. Results Serum PCT and IL-1β levels in the HAP group were significantly higher than those in the non-HAP group at day 3 and day 7（all P〈0.05）. In HAP group, serum levels of PCT and IL-1β significantly increased over time（all P〈0.05）. The ROC curve showed that the AUC（95% CI） of HAP patients with severe brain injury diagnosed by combination of PCT and IL-1β at day 3 was 0.908（0.847-0.969）, which was significantly higher than that of PCT [0.824（0.765-0.884） or IL-1β [0.817（0.756-0.872）], and its sensitivity and specificity were 91.2% and 86%, respectively. Conclusion Combination of PCT and IL-1β at day 3 is helpful to improve the diagnostic value of hospital acquired pneumonia in patients with severe traumatic brain injury.