CAJ | 학술논문

目的比较降钙素原、白细胞、中性粒细胞(N)及血清C-反应蛋白(CRP)检测在老年人感染性疾病中临床应用的价值. 方法采用我院电子病历、挂号和处方系统(HIS系统)收集年龄≥65岁、发热(腋温)＞38.0℃、有感染或疑似有感染征象,进行了降钙素原、白细胞及CRP检测及细菌学检查的相关病例,结合病史进行回顾性分析.并将治疗后的降钙素原、白细胞和CRP检测结果与治疗前进行比较. 结果入选患者219例,其中对照组65例,全身炎症反应综合征(SIRS)组48例,脓毒症组106例,脓毒症组中血白细胞计数正常组51例,异常组55例.脓毒症组病死率为11.4％(25/106),与SIRS组1.8％(4/48)及对照组0.9％(2/65)比较,差异有统计学意义(x2=15.660,P=0.000).血清降钙素原浓度与患者的感染程度呈正相关,Spearman相关系数为0.706(95％CI:0.616 ～0.797,P=0.000).以降钙素原、白细胞、CRP指标进行ROC曲线分析,降钙素原判断最佳诊断界值为＞0.341 μg/L(灵敏度为84.5％,特异度为55.8％);降钙素原比值对感染控制的曲线下面积(A)为0.916(95％CI:0.864～0.967,P=0.000),其判断感染的阈值为0.73 μg/L(灵敏度为84.6％,特异度为88.0％). 结论对老年感染性疾病患者进行降钙素原检测,能很好地反映出病情的变化,是特异性较高的炎症指标;降钙素原的变化可以指导临床抗生素的使用,从而避免滥用抗生素,减少细菌耐药性的产生.
목적 비교강개소원、백세포、중성립세포(N)급혈청C-반응단백(CRP)검측재노년인감염성질병중림상응용적개치. 방법 채용아원전자병력、괘호화처방계통(HIS계통)수집년령≥65세、발열(액온)＞38.0℃、유감염혹의사유감염정상,진행료강개소원、백세포급CRP검측급세균학검사적상관병례,결합병사진행회고성분석.병장치료후적강개소원、백세포화CRP검측결과여치료전진행비교. 결과 입선환자219례,기중대조조65례,전신염증반응종합정(SIRS)조48례,농독증조106례,농독증조중혈백세포계수정상조51례,이상조55례.농독증조병사솔위11.4％(25/106),여SIRS조1.8％(4/48)급대조조0.9％(2/65)비교,차이유통계학의의(x2=15.660,P=0.000).혈청강개소원농도여환자적감염정도정정상관,Spearman상관계수위0.706(95％CI:0.616 ～0.797,P=0.000).이강개소원、백세포、CRP지표진행ROC곡선분석,강개소원판단최가진단계치위＞0.341 μg/L(령민도위84.5％,특이도위55.8％);강개소원비치대감염공제적곡선하면적(A)위0.916(95％CI:0.864～0.967,P=0.000),기판단감염적역치위0.73 μg/L(령민도위84.6％,특이도위88.0％). 결론 대노년감염성질병환자진행강개소원검측,능흔호지반영출병정적변화,시특이성교고적염증지표;강개소원적변화가이지도림상항생소적사용,종이피면람용항생소,감소세균내약성적산생.
Objective To analyze and compare the clinical application values of procalcitonin (PCT),leukocyte count (WBC) and C-reactive protein(CRP) in elder patients with infection.Methods In patients(age≥ 65 yrs,axillary temperature ＞38.0℃)with infection or suspected infection,PCT,WBC,CRP and other bacteriological examination were performed.The electronic medical records from the HIS system of our hospital were analyzed retrospectively in combination with medical history.Results Of the enrolled 219 patients,65 ones were in control group,48 ones SIRS,51 ones sepsis and 55 ones MODS.There was a positive correlation between the level of serum PCT and the infection degree.The Spearman correlation coefficient was 0.706 (95％CI:0.616-0.797,P=0.000).Based on the highest Youden index (sensitivity+specificity-1),the best cutoff point of diagnosis for PCT was ＞0.341 μg/L (sensitivity 84.5％,specificity 55.8％),a analysis of receiver operating characteristic(ROC) curve about PCT,WBC and CRP was carried.Area under the curve (AUC) of PCT to controlled infection was 0.916 (95％CI:0.864-0.967,P=0.000).Based on the highest Youden index (sensitivity+ specificity-1),the judging threshold of PCT to infection controlled or not was 0.73 μg/L (sensitivity 84.6％,specificity 88.0％).PCT level after treatment ＞0.73 μg/L showed the uncontrolled infection,＜ 0.73 μg/L controlled.Conclusions PCT has a higher specificity for elder patients with infection.The variation of PCT level can guide the application of antibiotics,avoid abuse and decrease the occurrence of drug-resistant bacteria.