Objective To explore the change of procalcitonin (PCT),C-reactive protein (CRP),D-dimer and inflammatory mediators in severe pneumonia and its clinical significance.Methods Sixty-five patients that diagnosed as severe pneumonia and met criterions were collected from June 2011 to March 2015 in our hospital.They were divided into two groups according to different prognosis:improved group and death group.General informations of the two groups were comparable.The serum CRP,PCT,D-dimer,IL-6 and TNF-α level of two groups were determined on day 1,day 3,day 7 and the day of charge from ICU or death.Analyze the relationship between serum CRP,PCT,D-dimer,IL-6 and TNF-α level and prognosis.Results The serum CRP and PCT and D dimer level of improved group were gradually decreased (P ＜ 0.05),and those of death group were gradually increased (P ＜ 0.05).The serum CRP and PCT and D dimer level of two groups had no significant difference at day 1 after treatment (P ＞ 0.05).The serum CRP and PCT and D dimer level of improved group were lower than those of death group at day 3,day 7 and the day of charge from ICU or death.The levels of serum IL-6,TNF-α in of the two groups were gradually decreased (P ＜ 0.05).The serum IL-6 and TNF-α level of improved group were lower than those of death group at day 1,day 3,day 7 and the day of charge from ICU or death (P ＜ 0.05).Conclusions The serum CRP,PCT,D-dimer,IL-6 and TNF-α level can be used as effective index to assess the condition and prognosis of severe pneumonia.These indicators can not only understand the progress of the disease,but also to assess the effectiveness of treatment.%目的 探究重症肺炎患者血清降钙素原(PCT)、C-反应蛋白(CRP)、D二聚体及炎症因子水平变化及其临床意义.方法 自2011年6月-2015年3月收集该院呼吸科治疗并符合标准的65例重症肺炎患者,依据预后的不同将患者分为好转组与死亡组,两组患者一般资料差异无统计学意义,测定重症肺炎病程第1、3、7天转科或死亡前血清CRP、PCT、D二聚体、白细胞介素-6 (IL-6)、肿瘤坏死因子-α(TNF-α)水平,评估患者血清CRP、PCT、D二聚体、IL-6、TNF-α水平与患者预后之间关系.结果 好转组患者血清CRP、PCT及D二聚体水平逐渐下降(P＜0.05),死亡组患者血清CRP、PCT及D二聚体水平逐渐上升(P＜0.05),两组患者第1天血清CRP、PCT及D二聚体水平差异无统计学意义(P＞0.05),好转组第3、7天及转出或死亡前血清CRP、PCT及D二聚体水平明显低于同时段死亡组(P＜0.05),好转组与死亡组患者血清TNF-α与IL-6水平均逐渐下降(P＜0.05),好转组第1、3、7天及转出或死亡前血清TNF-α与IL-6水平明显低于同时段死亡组,差异有统计学意义(P＜0.05).结论 PCT、CRP、D二聚体、TNF-α与IL-6均可作为重症肺炎的病情评估及预后判断的指标,联合定期监测不仅可以了解病情的进展,而且可以评估治疗的有效性.
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