摘要
目的：探讨血清降钙素原（ PCT）与CRP水平对危重症患者呼吸机相关性肺炎预后判断的意义。方法采用前瞻性单中心研究方法，选择2013年11月至2015年10月收住重症监护病房（ ICU）确诊为呼吸机相关性肺炎（VAP）的患者67例，于确诊当日和确诊后第4、8天检测PCT与CRP。将67例患者按预后分为存活组（43例）和死亡组（24例）。结果67例VAP患者中有24例（35.8％）于确诊28 d内死亡。两组患者CRP在确诊当日和确诊后第4、8天比较差异均无统计学意义（ P＞0.05）。两组患者的血清PCT水平在确诊当日比较差异无统计学意义（ P＞0.05）；死亡组患者在确诊后第4、8天的PCT中位数（P25，P75）明显高于存活组[4 d：0.4（0.3，1.1）μg／L与4.7（2.3，10.8）μg／L，P＜0.05；8d：0.2（0.1，1.7）μg／L与3.9（3.2，14.8）μg／L，P＜0.05]。存活组患者的PCT水平从确诊当日[0.7（0.4，4.2）μg／L]至确诊后第8天[0.2（0.1，1.7）μg／L]显著降低（P＜0.05）。第4天的血清 PCT水平＞1μg／L是死亡的最强征兆，其比值比为23。结论 PCT是危重症患者VAP的重要预测标志物。第4天的PCT水平对预测VAP病死率非常关键。
Objective To study the prognostic value of procalcitonin（PCT） and C.reactive protein （ CRP ） in critically ill patients with ventilator.associated pneumonia （ VAP ）.Methods A single.center prospective observational study was conducted.A total of 67 cases patients with VAP admitted into intensive care unit（ICU） from November 2013 to October 2015 were enrolled and grouped as survivors（43 cases） and non.survivors（24 cases）.Blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis,and the 4th and 8th day after the diagnosis.Results There were 24 cases（35.8 %） died among the 28 days after the pneumonia diagnosis.There was no significant difference between the survivor and non.survivor groups in terms of PCT on the day of the pneumonia diagnosis（ P〉0.05） ,or CRP on the day of the pneumonia diagnosis, and the 4th and 8th day after the diagnosis （ P〉0.05）.But the PCT values on the 4th and 8th day were significantly higher in the non.survivor group than the survivor group（4 d：0.4（0.3,1.1） μg/L vs.4.7（2.3, 10.8） μg/L,P〈0.05;8 d：0.2（0.1,1.7） μg/L vs.3.9（3.2,14.8） μg/L,P〈0.05）.PCT levels decreased significantly from the day of the pneumonia diagnosis（0.7（0.4,4.2） μg/L） to the 8th day after the diagnosis （0.2（0.1,1.7） μg/L,P〈0.05） in the survivor group.The PCT level above 1 μg/L on the 4th day after the diagnosis was the strongest predictor of mortality,with an odds ratio of 23.Conclusion PCT is found to be a more important prognostic marker compared to CRP in terms of predicting mortality in critically ill patients with VAP.The PCT level on the 4th day after the diagnosis is the strongest predictor of mortality in VAP.
出处
《中国综合临床》
2016年第8期732-735,共4页
Clinical Medicine of China
基金
重庆市卫计委医学科研计划项目（2015MSXM077）
关键词
降钙素原
C反应蛋白
呼吸机相关性肺炎
预后
危重症
Procalcitonin
C-reactive protein
Ventilator-associated pneumonia
Prognosis
Critically ill
