联合检测血清指标对老年社区获得性肺炎患者预后的评估价值

The prognostic value of combined detection of serum indicators in elderly patients with community acquired pneumonia

目的分析联合检测血清C反应蛋白(CRP)、降钙素原和乳酸对老年社区获得性肺炎(CAP)患者预后的评估价值。方法选取商丘市第一人民医院急诊科95例老年CAP患者为病例组,同期选取商丘市第一人民医院急诊科45例老年体检健康人员为对照组,比较两组血乳酸、降钙素原和CRP的水平,同时比较病例组不同预后状况的患者血乳酸、降钙素原和CRP水平,通过绘制受试者工作特征曲线(ROC)评价CRP、降钙素原和血乳酸单独或联合检测对老年CAP患者预后状况的预测价值。结果与对照组比较,病例组血乳酸、降钙素原和CRP含量均明显升高(t=20.77、26.03,31.27,均P<0.01)。随访12个月,病例组死亡13例(13.68%、13/95)、存活82例(86.32%、82/95),死亡组血乳酸、降钙素原和CRP含量较存活组均明显升高(t=25.56、8.30,13.56,均P<0.01)。曲线ROC分析结果显示,血乳酸、降钙素原和CRP含量预测老年CAP患者预后的敏感度分别为76.92%、84.62%、69.23%,特异度分别为73.17%,78.05%,70.73%,而三者联合检测的敏感度和特异度较单独检测均明显升高,分别为92.31%、89.02%。结论老年CAP患者血乳酸、降钙素原和CRP含量明显升高,通过联合检测这三项血清学指标可提高对患者预后状况的预测价值,具有重要的临床意义。

Objective To evaluate the prognostic value of combined detection of serum C-reactive protein(CRP),procalcitonin and lactic acid in elderly patients with community acquired pneumonia(CAP).Methods Ninety-five elderly CAP patients in the emergency department of Shangqiu First People's Hospital were included as the case group,and 45 elderly healthy people in the emergency department of Shangqiu First People's Hospital were enrolled as the control group.Levels of blood lactic acids procalcitonin and CRP were compared between the two groups.Meanwhile,blood levels of lactic acid,procalcitonin and CRP were compared between patients with different outcomes in the case group.The receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of CRP,procalcitonin and blood lactic acid in elderly patients with CAP.Results Compared with the control group,blood levels of lactic acid,procalcitonin and CRP were increased in the case group(t=20.77,26.03 and 31.27,all P<0.01).During a 12-month follow-up,13 cases(13.68%,13/95)died and 82 cases(86.32%,82/95)survived in the case group.Blood levels of lactic acid,procalcitonin and CRP were higher in the death group than in the survival group(t=25.56,8.30 and 13.56,all P<0.01).ROC curve analysis showed that the sensitivity and specificity of serum lactic acid,procalcitonin and CRP in predicting the prognosis of elderly CAP patients were 76.92%and 73.17%,84.62%and 78.05%,and 69.23%and 70.73%,respectively.The sensitivity and specificity of combined detection of the three indicators were 92.31%and 89.02%,respectively>higher than those of the individual indicators.Conclusions Serum levels of lactic acid,procalcitonin and CRP are increased in elderly patients with CAP.Combined detection of the three indicators can improve the prognostic value and therefore has important clinical significance.