监测老年社区获得性肺炎患者血清降钙素原水平的临床意义

摘要

Objective To evaluate the significance of continuous monitoring of serum procalcitonin ( PCT) in elderly patients with community-acquired pneumonia. Methods All patients were given sputum bacteriology, and their mycoplasma pneumonia antibodies, chlamydia antibodies and serum PCT levels were detected before and 24 and 72 hours after the treatment. Subjects were divided into the high score group and the low score group score based on clinical pulmonary infection score. Taking serum PCT <0. 1 μg/L as the cut-off value, subjects were divided into two groups for statistical analysis. Results 20 cases of bacteriological sputum culture were positive, 10 cases of pos-itive mycoplasma pneumonia antibody, 2 cases of IgM positive chlamydia pneumonia antibody, and 26 cases of nega-tive bacteriological sputum culture. The level of PCT was higher in the sputum-positive group than in the atypical pathogens group and the sputum-negative group (P<0. 01). The level of serum PCT showed no significant difference between in the atypical pathogen group and the sputum-negative group ( P>0. 05 ) . The level of PCT was higher in the high-score group than in the low-score group (P<0. 05). The positive rate of PCT was higher in the high-score group than in the low-score group ( P<0. 05 ) . Conclusion Continuous monitoring of serum PCT level has some predictive value on the pathogen diagnosis in elderly patients with CAP, and the increased degree of PCT helps to e-valuate the severity of the infection in elderly patients with CAP.%目的：评价连续监测血清降钙素原( PCT)对老年社区获得性肺炎病原学诊断及判断病情严重程度中的意义。方法治疗前所有入选患者进行痰细菌学培养，肺炎支原体抗体、衣原体抗体及血清PCT测定。治疗后24 h、72 h再次检测血清PCT水平。根据临床肺部感染评分将研究对象分为高评分组及低评分组；按血清PCT<0．1μg/L作为界值将研究对象分为两层进行统计分析。结果①58例老年肺炎患者痰细菌学培养阳性20例，肺炎支原体抗体阳性10例，肺炎衣原体抗体IgM阳性2例，痰细菌学培养阴性26例。②痰菌阳性组PCT水平较非典型病原体组及痰菌阴性组高，且随治疗时间的推移呈逐渐下降的趋势，差异有统计学意义(P<0．01)。痰菌阴性组及非典型病原体组的血清PCT水平无明显变化规律，差异无统计学意义(P>0．05)。③高评分组PCT水平较低评分组高，差异有统计学意义(P<0．05)，高评分组PCT阳性率较低评分组高，差异有统计学意义(P<0．05)。结论连续监测血清PCT水平对老年CAP患者的病原诊断有一定的预测价值；且PCT升高程度有助于评价老年CAP感染的严重程度。