CT平扫联合PCT、CRP检测对ICU社区获得性肺炎诊断及预后评估的可行性分析

Feasibility Analysis of CT Non-enhanced Scan Combined with PCT and CRP in the Diagnosis and Prognosis Evaluation of Community-acquired Pneumonia in ICU

目的探讨CT平扫联合降钙素原(PCT)、C-反应蛋白(CRP)检测对ICU社区获得性肺炎(CAP)诊断及预后评估的可行性。方法对2016年1月至2018年3月于我院ICU收治的社区获得性重症肺炎患者94例做为重症组,另选取非重症肺炎者94例作为非重症组,收集患者临床资料及影像学资料,采用胸部CT评分对患者胸部CT肺部影像学程度进行分级,比较不同组别、预后患者PCT、CRP指标水平,采用Spearman相关性分析胸部CT评分与PCT、CRP水平的相关性,计算不同检查方法诊断CAP的灵敏度、特异度。结果PCT、CRP水平随着病情严重程度的增高逐渐上升,重症组患者PCT、CRP水平明显高于非重症组(P<0.05);不同预后患者PCT、CRP水平及胸部CT评分比较存在明显差异,存活组患者PCT、CRP水平明显低于死亡组(P<0.05);胸部CT平扫+PCT+CRP检查诊断CAP灵敏度、特异度为96.80%、94.68%,明显高于PCT+CRP及胸部CT平扫,差异有统计学意义(P<0.05),PCT+CRP及胸部CT平扫诊断CAP灵敏度、特异度比较无明显差异(P>0.05)。Spearman相关性分析结果显示胸部CT评分与PCT、CRP水平呈现正相关性(P<0.001)。结论CT平扫联合PCT、CRP检测诊断ICU CAP灵敏度、特异度高,CT评分与PCT、CRP水平呈现正相关,对评估患者预后有指导意义。

Objective To investigate the feasibility of CT non-enhanced scan combined with procalcitonin(PCT)and c-reactive protein(CRP)in the diagnosis and prognosis evaluation of community-acquired pneumonia(CAP)in ICU.Methods Between January 2016 and March 2018 in our hospital ICU community acquired 94 patients with severe pneumonia were as severe group.Other selected 94 cases without severe pneumonia as non severe group.The clinical data and imaging data of the patients were collected,and the chest CT score was used to grade the pulmonary imaging degree of the patients,and the PCT and CRP index levels of the patients in different groups and prognosis were compared.Spearman correlation was used to analyze the correlation between chest CT score,PCT and CRP level,and to calculate the sensitivity and specificity of different examination methods in diagnosing CAP.Results The levels of PCT and CRP increased gradually with the increase of the severity of the disease,and the levels of PCT and CRP in the critical care group were significantly higher than those in the non-critical care group(P<0.05).PCT,CRP levels and chest CT scores of patients with different prognosis were significantly different,and the PCT and CRP levels of patients in the survival group were significantly lower than those in the death group(P<0.05).The sensitivity and specificity of chest CT+PCT+CRP in the diagnosis of CAP were 96.80%and 94.68%,significantly higher than that of PCT+CRP and chest CT,and the difference was statistically significant(P<0.05).There was no significant difference in the sensitivity and specificity of PCT+CRP and chest CT in the diagnosis of CAP(P>0.05).Spearman correlation analysis showed that chest CT score was positively correlated with PCT and CRP levels(P<0.001).Conclusion CT scan combined with PCT and CRP has high sensitivity and specificity in the diagnosis of ICU CAP,and CT score is positively correlated with PCT and CRP level,which is of guiding significance for the prognosis evaluation of patients.