血清降钙素原在急性放射性肺炎和细菌性肺炎早期鉴别诊断中的价值

Value of serum procalcitonin in the early differential diagnosis of acute radiation pneumonia and bacterial pneumonia

目的探讨血清降钙素原在急性放射性肺炎(ARP)和细菌性肺炎(BP)鉴别诊断中的价值。方法收集2017年1月至2018年12月河北省唐山市人民医院收治的151例肺癌放疗合并急性肺炎患者的临床资料行回顾性分析,将患者分为ARP组(97例)和BP组(54例)。比较2组降钙素原、C反应蛋白(CRP)、白细胞计数(WBC)水平。应用受试者工作特征曲线评价各指标的诊断价值并确定临界值。结果ARP组的放疗处方剂量和平均肺受量均高于BP组,差异均有统计学意义(均P<0.05)。ARP组降钙素原水平低于BP组[0.40(0.29,0.84)μg/L比0.79(0.49,1.45)μg/L],差异有统计学意义(Z=-4.183,P<0.001);而ARP组与BP组CRP和WBC水平差异均无统计学意义[85.9(50.5,124.5)mg/L比103.6(73.3,125.7)mg/L、7.2(5.9,8.3)×10^9/L比7.3(5.8,9.3)×10^9/L](Z=-1.703,P=0.089;Z=-1.121,P=0.262)。降钙素原、CRP和WBC诊断ARP的受试者工作特征曲线曲线下面积(AUC)分别为0.706(95%置信区间:0.626~0.707,P<0.001)、0.584(95%置信区间:0.501~0.663,P=0.079)和0.555(95%置信区间:0.472~0.636,P=0.296),降钙素原AUC最大,最佳截断值为0.47μg/L。结论ARP患者血清降钙素原水平明显低于BP患者,降钙素原<0.47μg/L提示ARP诊断可能性大。

Objective To explore the value of serum procalcitonin in the early differential diagnosis of acute radiation pneumonia(ARP)and bacterial pneumonia(BP).Methods The clinical data of 151 patients with lung cancer treated on radiotherapy and complicated with acute pneumonia in Tangshan People’s Hospital,Hebei Province from January 2017 to December 2018 were retrospectively analyzed.The patients were divided into ARP group(97 cases)and BP group(54 cases).The levels of procalcitonin,C-reactive protein(CRP)and white blood cell count(WBC)were compared between the two groups.The diagnostic value of each index was evaluated and the critical value was determined by receiver operating characteristic(ROC)curve.Results The radiation prescription dose and average lung acceptance of ARP group were higher than those of BP group(both P<0.05).The procalcitonin level in the ARP group was lower than that in the BP group[0.40(0.29,0.84)μg/L vs 0.79(0.49,1.45)μg/L],with statistical difference(Z=-4.183,P<0.001);while there were no significant differences in CRP and WBC levels between the ARP group and the BP group[85.9(50.5,124.5)mg/L vs 103.6(73.3,125.7)mg/L,7.2(5.9,8.3)×10^9/L vs 7.3(5.8,9.3)×10^9/L](Z=-1.703,P=0.089;Z=-1.121,P=0.262).The area under curve(AUC)of ROC curve of procalcitonin,CRP and WBC in the diagnosis of ARP were 0.706[95%confidence interval(CI):0.626-0.707,P<0.001],0.584(95%CI:0.501-0.663,P=0.079)and 0.555(95%CI:0.472-0.636,P=0.296),respectively;the AUC of procalcitonin was the largest,with the best cut-off value of 0.47μg/L.Conclusions The procalcitonin level of ARP patients is significantly lower than that of BP patients.Procalcitonin<0.47μg/L indicates a high possibility of ARP diagnosis.