降钙素原对不同细菌致卒中相关性肺炎预测作用的临床研究

Clinical Study on the Predictive Effect of Procalcitonin on Stroke Associated Pneumonia Caused by Different Bacteria

目的探讨降钙素原(PCT)对不同细菌致卒中相关性肺炎(SAP)的预测作用,研究不同细菌感染所致SAP中PCT水平变化,了解PCT水平变化对革兰阴性(G^-)菌、革兰阳性(G^+)菌感染是否有鉴别意义。方法选取2015年12月至2017年6月收治住院的SAP患者60例,根据痰细菌培养鉴定结果分为G-菌感染组(31例)、G+菌感染组(29例),分别进行PCT和C反应蛋白(CRP)定量水平检测,对检测结果进行统计学分析,并用受试者工作特征曲线(ROC曲线)判断二者在G^-菌、G^+菌所致SAP中的诊断价值。结果PCT浓度在G-菌、G+菌感染组间差异有统计学意义(P<0.05);CRP浓度在G-菌、G+菌组间差异无统计学意义(P>0.05);G^-菌感染所致SAP患者PCT的ROC曲线下面积(AUC)为0.814,95%CI0.702~0.927,P<0.01,CRP的AUC为0.600,95%CI0.454~0.745,P=0.19;G^+菌感染所致SAP患者PCT的ROC曲线下面积(AUC)为0.186,95%CI0.073~0.298,P<0.01,CRP的AUC为0.400,95%CI0.255~0.564,P=0.18。结论PCT和CRP均可作为感染的特异性诊断指标,PCT在G^-菌、G^+菌所致SAP的鉴别诊断中具有重要的价值;PCT对G^-菌感染SAP的早期诊断及鉴别诊断价值高于CRP。

Objective To investigate the predictive effect of procalcitonin (PCT) on stroke associated pneumonia (SAP) caused by different bacteria,to study the change of PCT level in patients with SAP caused by different bacterial infection,and to evaluate whether the change of PCT level has differential significance for Gram-negative (G^-) bacteria and Gram-positive (G^+) bacteria infection.Methods 60 cases with SAP were selected in our hospital from Dec 2015 to June 2017,which were divided into G^- infection group (31 cases) and G^+ infection group (29 cases),according to sputum bacterial culture and identification.The levels of PCT and C-reactive protein (CRP) were detected respectively,and the results were statistically analyzed.The diagnostic value of the two groups was determined by the receiver operating characteristic curve (ROC curve).Results The concentration of PCT was statistically significant between the two groups ( P <0.05).There was no significant difference in the concentration of CRP between the two groups ( P >0.05).In the G^- bacteria infection group,the AUC of PCT was 0.814,95% CI 0.702-0.927,P <0.01,and the AUC of CRP was 0.600,95% CI 0.454-0.745,P =0.19.In the G^- bacteria infection group,the AUC of PCT was 0.186,95% CI 0.073-0.298,P <0.01,and the AUC of CRP was 0.400,95% CI 0.255-0.564,P =0.18.Conclusion Both PCT and CRP can be used as a specific diagnostic index for infection.PCT has important value in the differential diagnosis of SAP caused by G^- and G^+ bacteria.PCT is more valuable than CRP in the early diagnosis and differential diagnosis of G^- bacteria infection.