常用生物标志物及致病菌在社区获得性肺炎病情评估中的作用

摘要

Objective To investigate the role of pathogenic bacteria and six biomarkers ( procalcitonin ( PCT) , C-reactive protein ( CRP) , white blood cell ( WBC) , plasma fibrinogen ( FIB) and D-dimer( D-D) ) in the evaluation of the severity of community-acquired pneumonia. Methods A total of 318 CAP patients from January 2013 to December 2014 were enrolled in this study. PSI, CURB-65 and IDSA/ATS guidelines were used to assess the severity of CAP patients, and an analysis was performed to compare the prediction values of the biomarkers and patho-genic bacteria in CAP severity. Results The levels of PCT, CRP, WBC and D-dimer were significantly higher in the severe group (P<0. 05), while ESR and FIB had no significant difference in these groups (P>0. 05). The lev-els of PCT, CRP, WBC and D-dimer were significantly higher in the death group than in the survival group ( P<0. 05), while ESR and FIB had no significant difference in these groups (P<0. 05). The levels of PCT, CRP, WBC and D-dimer had correlation with PSI (r=0. 326, 0. 195, 0. 195, 0. 356, P<0. 05), and had correlation with CURB-65 (r=0. 297, 0. 187, 0. 172, 0. 297, P<0. 05). 78 strains of pathogenic microorganisms were isolated in 318 CAP patients. The positive rate of acinetobacter baumannii was significantly higher in the severe group and the death group than in the mild group and the survival group (P<0. 05). Conclusion PCT, CRP, WBC and D-dimer can predict the severity of CAP, and PCT and D-dimer could be used as two good biomarkers to assess the severity of patients with CAP. The positive rate of acinetobacter baumannii is significantly higher in the severe group and the death group.%目的 探讨常用生物标志物白细胞(WBC)、血沉(ESR)、C反应蛋白(CRP)、降钙素原(PCT)、纤维蛋白原(FIB)及D-二聚体(D-D)水平与社区获得性肺炎(CAP)严重程度的关系.同时,比较CAP严重程度分级之间致病菌的差异.方法 回顾性分析华中科技大学附属同济医院呼吸与危重症疾病科2013年1月至2014年12月收治的318例成人CAP患者WBC、ESR、CRP、PCT、FIB及D-D水平,比较CAP在严重指数(PSI)分级、(CURB-65)评分分级、非重症肺炎组与重症肺炎组、生存组与死亡组之间常用生物标志物表达的差异及相关性.通过回顾性分析患者痰培养、血培养结果,比较CAP在PSI分级之间致病菌的差异.结果按PSI及CURB-65分级,中高危组CAP患者PCT、CRP、WBC、D-D较低危组明显升高(P<0.05),两组ESR、FIB测定值无明显差异(P>0.05).按IDSA/ATS指南标准,重症CAP患者PCT、CRP、WBC、D-D较非重症患者明显升高(P<0.05),非重症患者FIB高于重症患者(P<0.05),两组ESR测定值无明显差异(P>0.05).死亡组CAP患者PCT、CRP、WBC、D-D明显高于生存组患者(P<0.05),两组ESR、FIB测定值无明显差异(P>0.05).PCT、CRP、WBC、D-D与PSI评分呈正相关(r=0.316,0.176,0.224,0.356,P<0.05),与CURB-65评分呈正相关(r=0.274,0.146,0.216,0.311,P<0.05),ESR、FIB与PSI、CURB-65评分无明显相关(P>0.05).318例成人CAP患者共培养出致病菌78株,其中中高危组及死亡组鲍曼不动杆菌检出率明显高于低危组及非死亡组(P<0.05).结论 PCT、CRP、WBC、D-D能反映CAP病情严重程度,其中PCT、D-D可以较好地评估CAP病情严重程度. 中高危组及死亡组鲍曼不动杆菌检出率较低危组及非死亡组明显升高.