不同病原菌所致重症肺炎患者白细胞计数、降钙素原、C-反应蛋白及白细胞介素-6水平

Levels of leukocyte count,procalcitonin,C-reactive protein and interleukin-6 among patients with severe pneumonia caused by different pathogens

目的探讨白细胞(WBC)计数、降钙素原(PCT)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)水平在不同病原菌所致重症肺炎患者中的差异,为重症肺炎的诊治提供理论依据。方法选取2014年10月至2017年3月在惠州市第一人民医院接受治疗且满足纳入标准的重症肺炎患者78例,根据病原菌种类将患者随机分为单一感染组:真菌组(F)、革兰阳性菌组(G+)、革兰阴性菌组(G-)和复合感染组:真菌+革兰阳性菌组(F+G+)、真菌+革兰阴性菌组(F+G-),共5组。比较各组患者PCT、CRP、WBC计数和IL-6水平。结果各组患者基础疾病、收缩压、体温、心率、红细胞沉降率差异均无统计学意义(P均>0.05);各组患者血清PCT水平差异有统计学意义(F=9.781、P=0.007);各组患者血清WBC水平差异均有统计学意义(F=8.373、P=0.005)。各组患者CRP和IL-6水平变化范围小,差异均无统计学意义(F=1.203、P=0.115,F=4.572、P=0.248)。结论低水平PCT和高水平CRP提示重症肺炎患者为真菌感染,降钙素原显著上升表明重症肺炎患者为革兰阴性杆菌感染或为复合感染。

Objective To investigate the count of white blood cell(WBC)levels,procalcitonin(PCT),C-reactive protein(CRP)and interleukin-6(IL-6)in patients with severe pneumonia caused by different pathogens,and to provide a theoretical basis for the diagnosis and treatment of pneumonia.Methods From October 2014 to March 2017,a total of 78 patients with severe pneumonia treated in the First People’s Hospital of Huizhou City who met the inclusion criteria were randomly divided into 5 groups according to the type of pathogenic bacteria,which were single infection group:fungi group(F),Gram-positive bacteria group(G^+),Gram-negative bacteria group(G^-)and coinfection group:fungi+Gram-positive bacteria group(F+G^+),fungi+Gram-negative bacteria group(F+G^-).The levels of PCT,CRP,WBC count and IL-6 were detected and compared,respectively.Results There was no significant difference among basic diseases,systolic blood pressure,body temperature,heart rate and erythrocyte sedimentation rate among the five groups(all P>0.05).There were significant differences in serum PCT and WBC levels among the five groups(F=9.781,P=0.007;F=8.373,P=0.005).Levels of CRP and IL-6 in each group were with small range of changes,but with no significant difference(F=1.203,P=0.115;F=4.572,P=0.248).Conclusions The low level of PCT and high level of CRP indicate that patients with severe pneumonia are infected by fungal,while the increase of procalcitonin indicates that patients with severe pneumonia are infected by Gramnegative bacilli or with compound infection.