目的：探析在早期诊断呼吸机相关性肺炎( VAP)中降钙素原( PCT)水平检测的临床意义。方法分析2013年4月-2015年4月在我院重症监护病房( ICU)接受机械通气治疗的30例确诊为VAP的患者( VAP组)的临床资料,另外选取16例无其它感染病灶、行呼吸机治疗及病情稳定期的患者作为本实验的非VAP组。比较两组患者的基线资料、机械通气前后各炎性指标的水平,并分析在VAP早期预测中PCT及其平均增加值△PCT的临床意义。结果两组患者的基线资料以及在机械通气前后的体温、WBC以及PCT值均无统计学差异(P>0．05)。与机械通气前相比,VAP组患者机械通气后的体温、WBC、PCT及肺部感染评分有所上升,并且比非VAP组患者的相应指标的水平高,两组间有统计学差异( P<0．05)。 PCT阈值在VAP预测方面的特异度是87．5%,灵敏度是90．0%,阳性预测值是93．1%,阴性为82．4%；△PCT阈值在VAP预测方面的特异度是93．8%,灵敏度是90．0%,阳性预测值是96．4%,阴性为83．3%；PCT+△PCT阈值在VAP预测方面的特异度是93．8%,灵敏度是100．0%,阳性预测值是96．8%,阴性为100．0%。结论血清PCT检测在VAP的早期诊断中有着重要的临床意义。%Objective To analyze the clinical significance of the detection of PCT in early diagnosis of venti-lator associated pneumonia (VAP). Methods The clinical data of 30 patients with VAP from 2013 to 2015 was ret-rospectively analyzed ( the VAP group) . 16 cases of non-other infection, ventilator therapy and stable condition pa-tients were chosen as the non-VAP group. The general information, the levels of inflammatory indexes before and after mechanical ventilation were compared. The clinical significance of PCT and△PCT in early diagnosing VAP was ana-lyzed. Results The general information and the temperature, WBC and PCT before and after mechanical ventilation had no statistical difference between the two groups (P>0. 05). Compared with temperature, WBC and PCT before mechanical ventilation, they increased after mechanical ventilation in the VAP group, and higher than those in the non-VAP group ( P<0. 05 ) . Taking PCT≥0. 5 ng/mL as threshold value, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of VAP was 90. 0%, 87. 5%, 93. 1% and 82. 4%. Taking △PCT at 0. 25-1. 70ng/mL as threshold value, the diagnostic sensitivity, specificity, the positive predictive value and negative predictive value of VAP was 90. 0%, 93. 8%, 96. 4% and 83. 3%. Taking PCT≥0. 5 ng/mL and△PCT at 0. 25-1. 70ng/mL as threshold value, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of VAP was 100. 0%, 93. 8%, 96. 8% and 100. 0%. Conclusion The detection of PCT in early diagnosing VAP has important significance.
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