CRP、PCT、CRP/PCT比值在成人肺炎支原体肺炎、细菌性肺炎中的变化及意义

Changes and significance of CRP,PCT,CRP/PCT ratio in adult Mycoplasma pneumoniae pneumonia and bacterial pneumonia

目的对比分析C-反应蛋白(c-reactive protein,CRP)、降钙素原(procalcitonin,PCT)和CRP/PCT比值在成人肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)和细菌性肺炎中的水平变化及意义,旨在提高MPP与其他类型细菌性肺炎的鉴别。方法选取2018年8月至2020年6月间入住我科的156例成人社区获得性肺炎(community-acquired pneumonia,CAP)患者,分为以下两组:MPP组(支原体抗体IgM阳性,n=66)和细菌性肺炎组(患有细菌性肺炎,n=90)。对比两组患者的CRP、PCT等检查指标的水平改变及临床特征,并利用受试者工作特征曲线(ROC)分析CRP、PCT及CRP/PCT比值在预测MPP患者中的价值。结果MPP组患者年龄显著小于细菌性肺炎组;细菌性肺炎组发生咳痰、胸闷的比例高于MPP组,而症状表现为干咳、肌痛的患者比例低于MPP组;与细菌性肺炎组患者胸部CT表现相比较,MPP组较少出现浸润实变及胸腔积液,而较多表现为小叶中心分布病灶及磨玻璃影。实验室检查:细菌性肺炎组PCT、CRP、白细胞计数及中性粒细胞计数水平高于MPP组,而CRP/PCT比值水平低于MPP组;以上差异均具有统计学意义(P<0.05)。ROC曲线分析显示:CRP、PCT及CRP/PCT比值预测患者MPP曲线下面积(AUC值)分别为0.64、0.86及0.89;灵敏度分别为89.4%、100%及87.9%;特异度分别为43.3%、55.6%及83.3%。结论MPP组与细菌性肺炎组中,CRP、PCT、CRP/PCT比值具有显著差异,以上检查指标结合临床特征及影像学特征表现可在MPP及细菌性肺炎的早期鉴别中发挥重要作用。

Objective To analyze the changes and significance of C-reactive protein(CRP),procalitonin(PCT)and clinical features in adults with mycoplasma pneumonia(MPP)and bacterial pneumonia,so as to enhance the discrimination patients with mycoplasma pneumonia from others with bacterial pneumonia.Methods 66 adult patients with positive results of Mycoplasma antibody IgM test,90 adult patients with bacterial pneumonia were selected.CRP,PCT and other examination indexes and clinical characteristics in the two groups of patients were compared.The value of CRP,PCT and CRP/PCT ratio in predicting MPP patients was analyzed by using receiver operating characteristic(ROC)curve.Results Patients diagnosed with MPP were remarkably younger than those with bacterial pneumonia.The incidence of expectoration and chest distress in bacterial pneumonia group was higher than that in MPP group,while the proportion of patients with symptoms of dry cough and myalgia was lower than that in MPP group.Compared with the chest CT in bacterial pneumonia group,MPP group had less invasive consolidation and pleural effusion,but more lesions in the center of the lobules and mass-like shadow.Laboratory examinations shown that the levels of PCT,CRP,white blood cell count and neutrophil count in bacterial pneumonia group were higher than those in MPP group,and the CRP/PCT ratio was lower than that in MPP group.All the differences above were statistically significant(P<0.05).The area-under-curve(AUC)values of CRP,PCT and CRP/PCT ratio in predicting patients with MPP were 0.64,0.86 and 0.89,respectively.The sensitivities of CRP,PCT and CRP/PCT ratio in predicting patients with MPP were 89.4%,100%and 87.9%,respectively.And the specificities were 43.3%,55.6%and 83.3%,respectively.Conclusion The levels of CRP,PCT,CRP/PCT ratio in MPP group and bacterial pneumonia group were significantly different.The above examination indexes combined with clinical characteristics and imaging features could play an important role in discriminating MPP from bacterial pneumonia.