降钙素原对老年呼吸机相关性肺炎早期判断病情及预后评估中的作用

摘要

目的 探讨老年呼吸机相关性肺炎(VAP)患者的血清降钙素原(PCT)与病情严重程度、疗效及预后的关系.方法 38例VAP患者根据预后分为存活组(22例)和死亡组(16例).采用微量双夹心免疫发光法分别于出现VAP后第1、3、5天进行血清PCT水平测定,同时检测并记录患者的外周血白细胞(WBC)、C反应蛋白(CRP)及急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分.结果 死亡组血清PCT水平明显高于存活组,(2.20±0.69) μg/Lvs (3.10±1.04) μg/L；存活组血清PCT水平随着感染控制后明显下降,死亡组无下降,两组治疗后第1、3和5天血清PCT水平分别为(2.20±0.69)μg/L vs(3.10±1.04)μg/L,(1.39±0.48) μg/L vs(3.78±2.29)μg/L,(0.82±0.30) μg/L vs(4.91±3.94)μg/L;第1天血清PCT水平与APACHEⅡ评分呈正相关(r＝0.420,P＜0.01).结论 血清PCT水平对早期判断老年VAP患者病情严重程度、疗效压预后具有重要价值.%Objective To investigate the relationship between serum procalcitonin levels and severity, curative effect,prognosis of elderly patients with ventilator-associated pneumonia(VAP). Methods Thirty-eight patients with VAP were divided into survivors group(n = 22) and nonsurvivors group( n =16). PCT serum levels were measured by immunoluminometric assay on days 1,3 and 5 for the patients with VAP. Simutaneously.CRP was measured, white blood cell counted and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ ) scores were recorded. ResultsPCT level in survivors group was significantly higher than that in nonsurvivors group, (2. 20 ±0. 69) μg/L vs (3.10 ± 1.04) μg/L;PCT level in survivors group decreased significantly with controlling infection. PCT level in nonsurvivors group did not decrease,after treatment for days 1,3 and 5,for PCT levels,two groups were respectively(2. 20+.0. 69) μg/L vs (3. 10±1.04) μg/L,U.39±0.48)μg/L vs (3.78±2.29) μg/L, (0. 82 + 0. 30) μg/L vs (4.91+3.94) μg/L; There was significant correlation between PCT levels and APACHEⅡ on the day 1( r =0.420, P <0. 01). ConclusionPCT level is valuable in predicting the severity of elderly patients with VAP and evaluating the curative effect and prognosis.