PCT 及 CRP 在肺部感染患者机械通气撤机中的预测价值

摘要

目的：探讨血浆降钙素原(procalcitonin,PCT)及 C 反应蛋白(CRP)水平与肺部感染患者机械通气撤机结局间的关系。方法回顾性分析入住广安门医院重症监护病房的重症肺部感染患者30例,在患者入院第二天及达到撤机标准行自主呼吸试验(spontaneous breathing trials,SBT)前检测 PCT 及 CRP 水平,如通过 SBT 则予撤机拔管。根据48 h 内的撤机结局,将患者分为成功组及失败组。比较两组间性别、年龄、A-PACHE Ⅱ评分、机械通气时间、PCT 及 CRP 水平,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC 曲线),计算曲线下面积(area under curve,AUC),评价 PCT 及 CRP 水平对撤机结局的预测价值。结果30例患者中,撤机成功组24例,失败组6例,两组男女比例、年龄及 APACHE Ⅱ评分、机械通气时间、入院第二天 PCT 及 CRP 水平差异无统计学意义(P >0．05)。撤机成功组撤机前 PCT 及 CRP 水平均较失败组低(P <0．05)。 PCT 的 ROC 曲线下面积(AUC)为(0．885±0．061),最佳截点值为0．71 ng/ ml,此时的敏感度为83．3%,特异性为20．8%；CRP 的 ROC 曲线下面积(AUC)为(0．382±0．138)(P >0．05)。结论 PCT 在预测肺部感染患者撤机结局中有一定价值,可作为撤机参考指标之一。%Objective To explore the relationship between serum procalcitonin (PCT), C-reactive protein (CRP) levels and the outcome for weaning from mechanical ventilation in patients with pulmonary infection. Meth-ods The clinical data of 30 patients with severe pulmonary infection were studied retrospectively. Their PCT and CRP levels were detected on the second day and before spontaneous breathing trials (SBT). If passed SBT, they would be given weaning and extubation. According to the weaning outcome within 48 hours, the patients were divided into the success group and the failure group. Their gender, age, APACHE Ⅱ scores, time of mechanical ventilation, and PCT and CRP levels were detected and compared. The area under ROC was used to evaluate the predictive value of PCT and CRP levels for weaning outcome. Results In 30 patients, 24 cases were succeeded, 6 cases failed. The two groups had no significant difference in gender, age, APACHE Ⅱ scores, time of mechanical ventilation, and PCT and CRP levels at the second day (P > 0. 05). The levels of PCT and CRP were lower in the success group than in the failure group before weaning (P < 0. 05). The AUC of PCT was (0. 885 ± 0. 061), with the optimal cut-off of 0. 71ng/ ml, and the sensitivity was 83. 3% and 20. 8% of the specificity. The AUC of CRP was (0. 382 ± 0. 138) (P > 0. 05). Conclusion PCT has certain value for predicting weaning outcome in patients with pulmonary infec-tion.