血清降钙素原在社区获得性肺炎诊治中的临床应用价值

doi:10.13481/j.1671-587x.20150229

吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (02): 352-355.doi: 10.13481/j.1671-587x.20150229

血清降钙素原在社区获得性肺炎诊治中的临床应用价值

李宁¹, 孙文伟², 赵建军¹, 谭平¹, 王静¹

1. 吉林大学中日联谊医院呼吸内科, 吉林长春 130033;
2. 吉林大学中日联谊医院核医学科, 吉林长春 130033

收稿日期:2014-10-21 出版日期:2015-03-28 发布日期:2015-04-04
通讯作者: 王静, 副主任医师(Tel:0431-84995860, E-mail:wangjing67@sina.com) E-mail:wangjing67@sina.com
作者简介:李宁(1987-), 女, 山东省济宁市人, 医师, 医学硕士, 主要从事呼吸系统感染性疾病诊治方面的研究。
基金资助:
国家自然科学基金资助课题(81372288)

Clinical value of serum procalcitonin in diagnosis and treatment of community acquired pneumonia

LI Ning¹, SUN Wenwei², ZHAO Jianjun¹, TAN Ping¹, WANG Jing¹

1. Department of Respiratory Medicine, China-Japan Union Hospital, Jilin University, Changchun 130033;
2. Department of Nuclear Medicine, China-Japan Union Hospital, Jilin University, Changchun 130033, China

Received:2014-10-21 Online:2015-03-28 Published:2015-04-04

摘要/Abstract

摘要：

目的:检测社区获得性肺炎(CAP)患者血清降钙素原(PCT)的水平,阐明其在CAP诊治中的意义。方法:选择127例CAP患者和30名健康对照者,127例CAP患者以合格痰标本细菌培养结果分为细菌培养阳性组(n=54)与细菌培养阴性组(n=73);根据重症肺炎诊断标准将细菌培养阳性组患者分为重症肺炎组(n=13)和非重症肺炎组(n=41)。采用双抗夹心免疫化学发光法检测研究对象血清PCT水平、白细胞(WBC)计数、中性粒细胞百分比(NEUT%)和C反应蛋白(CRP)水平。结果:治疗后第8天,细菌培养阳性组、细菌培养阴性组和健康对照组研究对象血清PCT水平比较差异无统计学意义(P>0.05);治疗后第8天,细菌培养阳性组和细菌培养阴性组研究对象血清PCT水平低于入院后第1天(P<0.05);重症肺炎组患者血清PCT水平明显高于非重症肺炎(P<0.01),重症肺炎组患者WBC计数、NEUT%和CRP水平虽均高于非重症肺炎组患者,但差异无统计学意义(P>0.05);以细菌培养阳性为诊断细菌感染的金标准,血清PCT水平诊断细菌性CAP的敏感度和特异度均优于NEUT%和WBC计数。结论:血清PCT水平对诊断CAP有一定的辅助价值,可指导判断CAP是否为细菌感染、评估肺炎的严重程度和停用抗生素的时机。

关键词: 社区获得性肺炎, 降钙素原, 白细胞计数, 中性粒细胞百分比, C反应蛋白

Abstract:

Objective To detect the level of serum procalcitonin(PCT) in the patients with community acquired pneumonia(CAP),and to clarify its significance in diagnosis and treatment of CAP.Methods 127 CAP patients and 30 cases of normal individuals were selected. According to the sputum bacterial culture results,127 CAP patients were divided into positive bacteria culture group (n=54)and negative bacteria culture group (n=73);according to the diagnostic criteria of severe pneumonia,the bacteria culture positive group was divided into severe pneumonia group (n=13) and non-severe pneumonia group(n=41). The levels of serum PCT,the white blood cell (WBC) count,neutrophil percentage(NEUT%) and levels of C-reactive protein (CRP) of the objects were detected by double antibody sandwich method.Results After treated for 8 d,the levels of serum PCT of the objects in positive bacteria culture group and negative bacteria culture group and normal control group had no significant differences. After treated for 8 d, the levels of serum PCT of the objects in positive bacteria culture group and negative bacteria culture group were lower than that of the objects on the first day after treatment.The level of serum PCT of the patients in severe pneumonia group was significantly higher than that in non-severe pneumonia group;the WBC count,NEUT% and CRP level of the patients in severe pneumonia group were higher than those in non-severe pneumonia group,but the difference was not statistically significant. When consindering the bacterial culture as the gold standard for diagnosis of bacterial infection,the sensitivity and specificity of the serum level in diagnosis of bacterial CAP were superior to NEUT% and WBC count.Conclusion The level of serum PCT plays a role in the diagnosis of CAP,and it could help to judge whether the CAP patient gets a bacterial infection and assess the severity of pneumonia and the discontinuation of antibiotics.

Key words: community acquired pneumonia, procalcitonin, white blood cell count, neutrophil percentage, C-reactive protein

中图分类号:

R563.1

李宁, 孙文伟, 赵建军, 谭平, 王静. 血清降钙素原在社区获得性肺炎诊治中的临床应用价值[J]. 吉林大学学报(医学版), 2015, 41(02): 352-355.

LI Ning, SUN Wenwei, ZHAO Jianjun, TAN Ping, WANG Jing. Clinical value of serum procalcitonin in diagnosis and treatment of community acquired pneumonia[J]. Journal of Jilin University Medicine Edition, 2015, 41(02): 352-355.

参考文献

[1] Schuetz P, Albrich WC,Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions[J].BMC Med,2011,9:107.doi:10.1186/1471-7015-9-107.

[2] Ruiz-Rodríguez J,Rello J. Predicting treatment failure in severe sepsis and septic shock[J]. Crit Care,2013,17(5):180.doi:10.1186/cc12877.

[3] Schuetz P,Maurer P,Punjabi V,et al. Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients[J]. Crit Care,2013,17(3):R115.

[4] 降钙素原急诊临床应用专家共识组.降钙素原急诊临床应用的专家共识[J].中华急诊医学杂志,2012,21(9):944-951.

[5] 中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南[J]. 中华结核和呼吸杂志, 2006, 29(10):651-655.

[6] 何礼贤.降钙素原指导严重细菌感染和脓毒血症诊疗的临床意义[J].中华结核和呼吸杂志,2012,35(8):636-637.

[7] Jekarl DW,Lee SY,Lee J,et al. Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis[J]. Diagn Microbiol Infect Dis,2013,75(4):342-347.

[8] Krüger S,Ewig S,Marre R,et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes [J]. Eur Respir J,2008,31(2):349-355.

[9] Espaa PP,Capelastegui A,Bilbao A,et al. Utility of two biomarkers for directing care among patients with non-severe community-acquired pneumonia [J]. Eur J Clin Microbiol Infect Dis,2012,31(12):3397-3405.

[10] Nyamande K,Lalloo UG.Serum procalcitonin distinguishes CAP due to bacteria, Mycobacterium tuberculosis and PJP [J].Int J Tuberc Lung Dis,2006,10(5):510-515.

[11] Huang DT,Weissfeld LA,Kellum JA,et al.Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia [J].Ann Emerg Med, 2008,52(1):48-58.

[12] Johansson N,Kalin M,Backman-Johansson C,et al. Procalcitonin levels in community-acquired pneumonia correlation with aetiology and severity[J]. Scand J Infect Dis,2014,46(11):787-791.

[13] Park JH,Wee JH,Choi SP,et al.The value of procalcitonin level in community-acquired pneumonia in the ED[J].Am J Emerg Med,2012,30 (7):1248-1254.

[14] Kim JH,Seo JW,Mok JH,et al.Usefulness of plasma procalcitonin to predict severity in elderly patients in community-acquired pneumonia [J]. Tuberc Respir Dis (Seoul),2013,74 (5):207-214.

[15] Woodhead M,Blasi F,Ewig S,et al.Guidelines for the management of adult lower respiratory tract infections[J].Clin Microbiol Infect,2011,17(Suppl 6):E1-E59.

[16] Schuetz P,Briel M,Mueller B,et al. Clinical outcomes associated with procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections [J].JAMA,2013,309(7):717-718.

[17] Stolz D,Christ-Crain M,Bingisser R,et al. Antibiotic treatment of exacerbations of COPD:a randomized,controlled trial comparing procalcitonin guidance with standard therapy[J].Chest,2007,131(1):9-19.

[18] Fazili T,Endy T,Javaid W,et al. Role of procalcitonin in guiding antibiotic therapy[J]. Am J Health Syst Pharm,2012,69 (23):2057-2061.

[19] Albrich WC,Dusemund F,Bucher B,et al. Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in "real life":an international,multicenter post study survey (ProREAL) [J]. Arch Intern Med,2012,172 (9):715-722.

[20] Schuetz P,Chiappa V,Briel M,et al. Procalcitonin algorithms for anti-biotic therapy decisions:a systematic review of randomized controlled trials and recommendations for clinical algorithms[J].Arch Intern Med,2011,171(15):1322-1271.

[21] 郭娟,陈国勇,杨霄,等. 血清降钙素原水平在肝移植术后并发肺部感染患者中的诊断价值[J].中国老年学杂志,2014,34(22):6245-6247.

[22] 蔡川奇,林志鸿,蔺佩鸿,等.血清白蛋白和前白蛋白对老年肺炎病情的预测价值[J].中国老年学杂志,2014,34(1):103-105.

血清降钙素原在社区获得性肺炎诊治中的临床应用价值

Clinical value of serum procalcitonin in diagnosis and treatment of community acquired pneumonia

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