标题：血清PCT对慢性肾脏病合并社区获得性肺炎的诊断价值

      作者：王艳 1，2，杨岚 3    (1.西安交通大学医学院，陕西 西安 710000；2.榆林市星元医院内一科，陕西 榆林 719000；3.西安交通大学第一附属医院呼吸与危重症医学科，陕西 西安 710000)

      卷次： 2018年29卷24期

      【摘要】 目的 探讨血清降钙素原(PCT)对慢性肾脏病合并社区获得性肺炎的临床诊断价值。方法 选取2016年3月至 2018年3月间榆林市星元医院诊治的34例慢性肾脏病合并社区性肺炎患者为肺炎组，65例慢性肾脏病合并肺外感染患者为感染组，65例慢性肾脏病无感染患者为无感染组，30例健康中老年人为对照组，运用受试者工作特征曲线(ROC)评价PCT对慢性肾脏病合并社区获得性肺炎的诊断价值，并观察PCT水平与肺炎严重程度(URB-65评分)相关性。结果 PCT对诊断慢性肾脏病患者是否合并感染的曲线下面积(AUC)为 0.91，诊断敏感性、特异性、阳性预测值、阴性预测值分别为0.735、0.938、0.978、0.612，最佳临界值为0.54 ng/mL；对鉴别诊断合并社区获得性肺炎和一般感染的AUC为 0.89，敏感性、特异性、阳性预测值、阴性预测值分别为 0.746、0.944、0.718、0.227，最佳临界值为0.71 ng/mL；血清PCT水平与URB-65评分及抗菌药物治疗时间成正比(r=0.692、0.616，P<0.05)。结论 PCT可用于诊断慢性肾脏病合并社区获得性肺炎，并能够对肺炎严重程度以及治疗时长做出相应评估。
      【关键词】 降钙素原；慢性肾脏病；社区获得性肺炎；感染；诊断价值
      【中图分类号】 R692 【文献标识码】 A 【文章编号】 1003—6350（2018）24—3430—03

Diagnostic value of serum PCT for chronic kidney disease complicated with community-acquired pneumonia.WANG Yan 1,2, YANG Lan 3.
1. Health Science Center, Xi'an Jiaotong University, Xi'an 710000, Shaanxi, CHINA; 2. FirstDepartment of Internal Medicine, Xingyuan Hospital of Yulin, Yulin 719000, Shaanxi, CHINA; 3. Department of RespiratoryAnd Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To investigate the diagnostic value of serum procalcitonin (PCT) for chronic kidney dis-ease complicated with community-acquired pneumonia. Methods Among them, 34 patients with chronic kidney dis-ease combined with community-acquired pneumonia who were diagnosed and treated in Xingyuan Hospital of Yulinfrom March 2016 to March 2018 were selected as the pneumonia group, 65 patients with chronic kidney disease com-bined with extrapulmonary infection as the infection group, 65 patients with chronic kidney disease without infectionas the non-infected group, and 30 healthy middle-aged and old people as the control group. The receiver operatingcharacteristic (ROC) curve was used to evaluate the diagnostic value of PCT for chronic kidney disease with communi-ty-acquired pneumonia, and to observe the correlation between PCT level and severity of pneumonia (URB-65 score).Results The area under the curve (AUC) of PCT was 0.91 for diagnosis of co-infection in patients with chronic renaldisease, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value were 0.735, 0.938,0.978, and 0.612, respectively, and the best critical value was 0.54 ng/mL. The AUC was 0.89 for differential diagnosisof community-acquired pneumonia and general infection, the sensitivity, specificity, positive predictive value and nega-tive predictive value were 0.746, 0.944, 0.718, 0.227, respectively, and the best critical value was 0.71 ng/mL. The serumPCT level was directly proportional to the URB-65 score and the duration of antibiotic treatment (r=0.692, 0.616, P<0.05). Conclusion PCT can be used to diagnose chronic kidney disease complicated with community-acquired pneu-monia, and to evaluate the severity of pneumonia and the duration of treatment.
      【Key words】 Procalcitonin; Chronic kidney disease; Community-acquired pneumonia; Infection; Diagnostic value·论 著·doi:10.3969/j.issn.1003-6350.2018.24.009