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      标题:血清降钙素原水平与重症肺炎伴ARDS发病的相关性及对病情严重程度的评估价值
      作者:王海霞,彭亚岚,吕林    (攀枝花市第二人民医院呼吸科,四川 攀枝花 617068)
      卷次: 2018年29卷10期
      【摘要】 目的 研究血清降钙素原(PCT)水平变化与重症肺炎伴急性呼吸窘迫综合征(ARDS)发病的相关性及评估病情严重程度的价值。方法 随机选取2015年9月至2017年5月攀枝花市第二人民医院呼吸科收治的43例重症肺炎伴ARDS患者为A组,于同期再收集45例重症肺炎患者为B组,22例普通肺炎患者为C组,22例体检健康人员为D组。比较治疗前、治疗24 h、48 h、治疗结束后A、B、C组患者的血清PCT、白细胞计数(WBC计数)、C反应蛋白(CRP)、白介素-6 (IL-6)水平和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分),并分别与D组进行比较。结果 治疗前、治疗24 h、48 h,A组患者的血清PCT、WBC计数、CRP、IL-6水平和APACHEⅡ评分高于B组,B组高于C组,C组高于D组,差异均有统计学意义(P<0.05);A、B、C组患者治疗48 h、治疗结束后上述指标水平和评分均低于治疗前,差异均有统计学意义(P<0.05);治疗结束,A、B、C组分别与D组受检者的上述各项指标比较差异均无统计学意义(P>0.05);PCT曲线下面积(AUC) 0.829、WBC计数AUC 0.580、CRP AUC 0.714、IL-6 AUC0.790;PCT评价重症肺炎伴ARDS发病敏感度为81.40%、特异性为94.44%和阳性预测值为93.33%,均高于WBC计数、CRP和 IL-6的敏感度、特异性和阳性预测值。PCT水平均与WBC计数、CRP水平、IL-6水平、APACHEⅡ评分呈正相关(P<0.05)。结论 动态监测血清PCT水平变化有助于预测重症肺炎伴ARDS发病及病情严重程度,从而指导临床治疗,改善预后,且其价值优于WBC计数、CRP、IL-6等传统指标和APACHEⅡ评分,尤其适合基层医院推广应用。
      【关键词】 重症肺炎;急性呼吸窘迫综合征;降钙素原;相关性
      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350(2018)10—1397—04
Correlation between serum procalcitonin levels and severe pneumonia-associated ARDS incidence and itsseverity assessment. WANG Hai-xia, PENG Ya-lan, LV Lin. Department of Respiration, the Second People's Hospital ofPanzhihua, Panzhihua 617068, Sichuan, CHINA
      【Abstract】 Objective To study the correlation between the changes of serum procalcitonin (PCT) level and theincidence of severe pneumonia-associated acute respiratory distress syndrome (ARDS) incidence, and assess the value ofthe severity of the disease. Methods From September 2015 to May 2017, 43 patients with severe pneumonia complicat-ed with ARDS, who admitted to Department of Respiration of the Second People's Hospital of Panzhihua City, were ran-domly selected as group A. Meantime, 45 patients with severe pneumonia were recruited as group B, 22 patients with com-mon pneumonia were enrolled into group C, and 22 cases of physical health personnel were selected as group D. The se-rum levels of procalcitonin (PCT), white blood cell count (WBC count), C-reactive protein (CRP), interleukin-6 (IL-6)and Acute Physiology and Chronic Health Enquiry (APACHEⅡ) score before treatment and after 24 h, 48 h and 7 d oftreatment were measured and compared between the four groups. Results The levels of PCT, WBC, CRP, IL-6 andAPACHEⅡ before treatment and after 24 h and 48 h of treatment in group A, group B, group C and group D decreasedsequentially, and the differences between them were significant (P<0.05). The above indexes after 48 h and 7 d of treat-ment in group A, group B, group C were significantly lower than those before the treatment (P<0.05). Compared withgroup A, group B, group C, respectively, there was no significant difference in the above indexes after the treatment forgroup D (P>0.05). The area under the curve (AUC) of PCT, WBC count, CRP, IL-6 were 0.829, 0.580, 0.714, 0.790, re-spectively. The sensitivity, specificity and positive predictive value of PCT in the evaluation of severe pneumonia withARDS were 81.40%, 94.44%, 93.33%, respectively, which were all significantly higher than those of WBC count, CRP,IL-6 (P<0.05). PCT levels were positively correlated with WBC count, CRP level, IL-6 level and APACHE Ⅱ score(P<0.05). Conclusion The dynamic monitoring of serum PCT level can help to predict the onset of severe pneumoniawith ARDS and the severity of the disease, so as to guide the clinical practices and improve the prognosis, and its valueis better than WBC count, CRP, IL-6 and other traditional indicators and APACHEⅡ score, especially suitable for popu-larization and application in grass-roots hospitals.
      【Key words】 Severe pneumonia; Acute respiratory distress syndrome (ARDS); Procalcitonin (PCT); Relevance·论 著·doi:10.3969/j.issn.1003-6350.2018.10.020
      基金项目:四川省攀枝花市科技局科技计划项目(编号:2015ZD-S-3)

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