血清降钙素原在老年下呼吸道感染中的临床意义

摘要

目的 探讨血清降钙素原对老年下呼吸道感染患者的诊断、病情评估、疗效监测及预后判断的价值.方法 将老年下呼吸道感染患者80例(感染组)分为预后良好及预后不良组;另设立正常对照组;于入院后24 h内测感染组及正常对照组血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、WBC、中性粒细胞百分比(N)及第8天感染组以上各项指标,动态观察各项炎性指标的变化;并记录感染组入院24 h内及经抗感染治疗后第8天急性简化生理学评分(SAPSⅡ评分),对病情进行评定.结果 感染组患者第1天血清PCT水平高于正常对照组(P<0.05);PCT指标的灵敏度(85%)和特异度(90%)均较高,PCT的ROC曲线下面积高于hs-CRP、WBC、N;预后不良组第1天及第8天PCT值明显高于预后良好组,预后良好组第1天PCT明显高于第8天(P均<0.01); PCT水平与SAPSⅡ评分明显正相关(r=0.404,P<0.01).结论 血清PCT水平可反映老年下呼吸道感染患者病情严重程度及预后,是其诊断的一个较好指标.%Objective To investigate clinical application value of the serum procalcitoin and the relationship between serum procalcitoin (PCT) and diagnosis, treatment and condition assessment in patients with lower respiratory tract infections (LRTI) in the eldly. Methods The LRTI group ( n =80) was further divided into good prognosis and poor prognosis ( no improvement or death) group, as well as another health normal control group with 60 cases. In LRTI groups and the normal group, serum procalcitoin, high-sensitivity C-reactive protein, white blood cell, neutrophils percentage in 24 hours and the above indicators in the 8th-day in infection group were detected, observing dynamically various inflammatory indicators, and recording the Simplified Acute Physiology Score (SAPS Ⅱ ) of the LRTI group within 24 h after admission and after anti-infection treatment for 8 days, and then evaluating the illness. Results PCT in LRTI group was higher than that in normal control group (P ＜ 0.05) at the first day. The sensitivity of PCT index (85％) and specific degrees (90％) were higher, the ROC curves under area (AUC) of PCT was higher than that of hsCRP, WBC, N. PCT was a good indicator of diagnosing the LRTI in the elderly; In the poor prognosis group, PCT values at the first day and 8 th day were obviously higher than those in good prognosis group(P ＜0.05). The PCT at the first day was obviously higher than that at 8th day in the good prognosis group; PCT level and SAPS Ⅱ seore were significantly positive correlated ( r =0. 404, P ＜0.01 ).Conclusions The PCT level is related to the severity of eldly lower respiratory infection and prognosis, is a good diagnosis index.