血清和胸腔积液降钙素原对肺炎旁胸腔积液病情评估和诊治的临床价值

摘要

目的评价血清降钙素原（S-PCT）和胸腔积液降钙素原（PF-PCT）水平在肺炎旁胸腔积液（PPPE）患者病情评估和诊治中的临床价值。方法80例PPPE患者分为两组：单纯性肺炎旁胸腔积液（UCPE）组42例、复杂性肺炎旁胸腔积液（CPE）组38例，另选定30例漏出液患者作为对照组。检测3组胸腔积液的pH值、葡萄糖、LDH，S-PCT和PF-PCT水平。结果3组胸腔积液的pH值、葡萄糖、LDH均有统计学意义（均P＜0.05）。UCPE组、CPE组S-PCT和PF-PCT均较对照组明显升高（均P＜0.01），UCPE组、CPE组间S-PCT无统计学意义（P＞0.05），UCPE组、CPE组间PF-PCT有统计学意义（P＜0.05）；S-PCT与PF-PCT之间呈正相关性（r=0.70，P＜0.05）。S-PCT与PF-PCT在肺炎严重指数（PSI）评分分层的高风险者明显升高（P＜0.05），住院天数＞3周和发生并发症及死亡者的S-PCT及PF-PCT分别较住院天数＜3周和未发生并发症及死亡者的明显增高，均有统计学意义（均P＜0.05），胸膜增厚者和外科手术者PF-PCT/S-PCT分别较非胸膜增厚者和非外科手术者明显下降，均有统计学意义（均P＜0.05）；PF-PCT＞0.25ng/ml （临界值）时被认为对CPE有诊断意义，敏感度为80%，特异度为76%。结论 S-PCT和PF-PCT对PPPE病情评估有临床意义；PF-PCT对CPE有诊断意义，可对临床治疗起到指导作用；PF-PCT/S-PCT可以预测胸膜增厚程度和外科手术率。%Objective To investigate the application of serum and pleural fluid procalcitonin(S-PCT and PF-PCT) levels in evaluation of patients with parapneumonic pleural effusion (PPPE). Methods Eighty patients with PPPE were included in the study, including 42 cases of uncomplicated pleural effusion (UCPE) and 38 cases of complicated pleural effusion (CPE);30 pa-tients with transudate patients served as controls. The PH, glucose and lactate dehydrogenase (LHD) levels in pleural fluid or in trasnudate as wel as S-PCT and PF-PCT were measured in three groups. Results There were significantly difference in PH, glucose and LDH among three groups (P<0.05).The levels of S-PCT and PF-PCT were higher in PPPE patients than those in controls(P<0.01). There were no significantly difference in S-PCT levels between UCPE and CPE groups(P>0.05),but the differ-ence in PF-PCT levels was significant (P<0.05). The S-PCT level was positively correlated with PF-PCT level in three groups(r=0.70, P<0.05). Both S-PCT and PF-PCT levels significantly increased in high risk patients classified by the PSI score (P<0.05), whose hospital stay>3 weeks, or in whom complications or death occurred (P<0.05). PF-PCT/S-PCT levels were significantly decreased in patients who had pleural thickening or need surgical procedures (P<0.05). The cut-off value of PF-PCT >0.25ng/mL was used for diagnosis of CPE with a sensitivity of 80%and specificity of 76%. Conclusion The levels of S-PCT and PF-PCT can be used in clinical evaluation of patients with PPPE;PF-PCT may differentiate UCPE from CPE, which need thoracic closing drainage, thoracic injection of fibrinolytic agents or possible thoracoscopic surgery for treatment.