降钙素原对老年人急性左心衰竭并发肺部感染的早期诊断意义

Clinical significance of procalcitonin in early diagnosis of acute left heart failure complicated with pulmonary infection in the elderly

目的分析降钙素原(PCT)对老年人急性左心力衰竭(心衰)并发肺部感染的早期诊断意义。方法回顾性分析我院急诊2012年8月至2018年2月收治入院治疗的老年急性左心衰及急性左心衰合并肺部感染患者共113例,采集患者收治入院后第1天及第3天的血清PCT浓度数据,结合患者的诊断情况计算血清PCT、C-反应蛋白(CRP)的诊断意义;通过绘制受试者操作特性(ROC)曲线评估PCT的诊断界值。结果合并肺部感染组老年患者在入院第1天及第3天血清PCT表达分别为(2.45±0.42)μg/L、(1.25±0.17)μg/L,均高于左心衰组(0.54±0.03)μg/L、(0.43±0.03)μg/L,差异具有统计学意义(t=34.27、35.78,均P=0.000)。PCT诊断的特异性、阳性预测值及阴性预测值均优于CRP(χ^2=4.97、4.76、4.17,P=0.030、0.030、0.040),诊断敏感性PCT与CRP比较差异无统计学意义(χ^2=3.05,P=0.080)。PCT最佳诊断界值为0.597 μg/L,此时诊断老年患者心力衰竭合并肺部感染的敏感性为91.07%、特异性为90.77%。结论血清PCT检测能够辅助早期诊断老年患者急性左心衰并发肺部感染,具有较高的敏感性及特异性,其最佳诊断界值PCT为0.597 μg/L,通过实现早期诊断使患者早期合理应用抗生素控制病情。

Objective To investigate clinical significance of procalcitonin(PCT)in the early diagnosis of acute left heart failure complicated with pulmonary infection in the elderly. Methods A total of 113 patients with acute left heart failure or acute left heart failure complicated with pulmonary infection who were admitted into our emergency department from August 2012 to February 2018 were retrospectively analyzed.Data of serum concentration of PCT were collected on the first and third days after admission.The diagnostic values of serum PCT and C-reaction protein(CRP)were evaluated based on the patient's diagnostic data.ROC curves were plotted for PCT, and its cut-off value was calculated. Results Serum levels of PCT on the first and third days after admission were higher in pulmonary infection group than in left heart failure group[(2.45±0.42)μg/L vs.(0.54±0.03)μg/L,(1.25±0.17)μg/L vs.(0.43±0.03)μg/L, t=34.27 and 35.78, P=0.000 and 0.000]. The diagnostic specificity, positive predictive value, and negative predictive value of PCT were better than those of CRP(χ^2=4.97, 4.76 and 4.17, P=0.030, 0.030 and 0.040). There was no significant difference in the diagnostic sensitivity between PCT and CRP(χ^2=3.05, P=0.080). The best diagnostic cut-off value of PCT was 0.597 μg/L in which the sensitivity of diagnosis of heart failure complicated with pneumonia was 91.07% and the specificity was 90.77%. Conclusions Serum PCT test can assist the early diagnosis of acute left heart failure complicated with pulmonary infection in elderly patients with high sensitivity and specificity.The best diagnostic cut-off value of PCT is 0.597 μg/L.Based on serum PCT test, early rational use of antibiotics for controlling acute left heart failure complicated with pulmonary infection in elderly patients is worthy of generalization.