PCT在诊断重症社区获得性肺炎并弥散性血管内凝血中的意义

Significance of PCT in the Diagnosis of Severe Community-acquired Pneumonia with Disseminated Intravascular Coagulation

目的:探讨降钙素原(PCT)在早期预测重症社区获得性肺炎(SCAP)并发弥散性血管内凝血(DIC)中的诊断价值。方法:回顾性分析2016年1月-2018年5月本院收治的SCAP患者161例的临床资料。根据患者住院期间有无并发DIC分为SCAP组(n=115)和DIC组(n=46)。检测并分析两组中性粒细胞百分比、C-反应蛋白(CRP)及PCT水平,绘制受试者工作曲线(ROC)并评价各指标预测DIC形成的诊断效能。结果:DIC组中性粒细胞百分比、CRP、PCT水平均高于SCAP组,差异均有统计学意义(P<0.05);ROC曲线显示,PCT预测SCAP并发DIC的AUC显著高于中性粒细胞百分比、CRP(P<0.05),其中PCT最佳截点为3.11 ng/mL,中性粒细胞百分比最佳截点为89.66%,CRP最佳截点为102.34 mg/L,PCT预测SCAP并发DIC的诊断准确度、灵敏度、阳性预测值均高于中性粒细胞百分比和CRP(P<0.05)。结论:血清PCT水平在预测SCAP并发DIC中具有较高价值,其中PCT≥3.11 ng/mL,中性粒细胞百分比≥89.66%,CRP≥102.34 mg/L可作为风险预警指标。

Objective:To explore the diagnostic value of procalcitonin(PCT)in early prediction of severe community-acquired pneumonia(SCAP)complicated with disseminated intravascular coagulation(DIC). Method:The clinical data of 161 patients with SCAP admitted to our hospital from January 2016 to May 2018 were analyzed retrospectively.According to whether they had DIC during hospitalization,they were divided into SCAP group (n=115)and DIC group(n=46).The percentage of neutrophils,C-reactive protein(CRP)and PCT levels were detected and analyzed in both groups,the ROC was plotted and the diagnostic efficacy of each index in predicting the formation of DIC was evaluated.Result:The percentage of neutrophils,CRP and PCT levels in DIC group were higher than those of SCAP group(P<0.05).ROC curve showed that PCT predicted AUC of SCAP complicated with DIC was significantly higher than that of neutrophil percentage and CRP(P<0.05),the best cut-off point of PCT was 3.11 ng/ mL,the neutrophil percentage was 89.66%,and the CRP was 102.34 mg/L,the diagnostic accuracy,sensitivity and positive predictive value of PCT in predicting SCAP complicated with DIC were higher than that of neutrophil percentage and CRP(P<0.05).Conclusion:Serum PCT level has high value in predicting SCAP complicated with DIC, PCT≥3.11 ng/mL,N≥89.66%,and CRP≥102.34 mg/L can be used as risk early warning indicators.