CAJ | 학술논문

目的探讨血清降钙素原(procalcitonin,PCT)水平在诊治急性发热患者中的临床价值.方法选取2011年9月至2012年5月,广东省江门市中心医院急诊科诊治的急性发热患者285例,随机(随机数字法)分为2组:常规组122例和PCT组163例.均测定血常规、C-反应蛋白,并通过病原学或血清免疫学检查明确诊断；PCT组患者加测PCT.常规组按照抗生素指南进行治疗,PCT组根据PCT质量浓度指导抗生素治疗.比较2组的抗生素费用及疗程、使用率及临床有效率和病死率.PCT组按感染的判定标准分为3个亚组:细菌感染组、病毒感染组和非感染组.采用成组t检验、x2检验、单因素方差分析,最小显著法等统计方法,比较各组炎症指标对诊断细菌感染的价值.PCT组按照预后不同,分为预后良好组和预后不良两组,比较两组间血清PCT质量浓度,评价其与细菌感染患者预后的关系.结果常规组和PCT组抗生素的费用及使用率、疗程分别是(3586.5 ± 703.3)元、95.08％、(15.01 ±11.21)d和(1871.2 ±433.5)元、54.60％、(11.22±7.10)d,差异具有统计学意义(P＜0.01)；临床有效率、病死率差异无统计学意义(P＞0.05).血清PCT质量浓度在细菌感染组(1.12±0.88) ng/ml均高于病毒感染组(0.21±0.11) ng/ml和非感染组(0.18±0.13)ng/ml,差异具有统计学意义(P＜0.01)；而后2组的PCT值差异无统计学意义(P＞0.05).PCT诊断细菌感染的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)均优于其他炎症指标.结论血清PCT质量浓度对急诊医师鉴别诊断急性发热的性质、预后优于其他炎症指标,对临床合理使用抗生素有重要指导意义.
목적 탐토혈청강개소원(procalcitonin,PCT)수평재진치급성발열환자중적림상개치.방법 선취2011년9월지2012년5월,광동성강문시중심의원급진과진치적급성발열환자285례,수궤(수궤수자법)분위2조:상규조122례화PCT조163례.균측정혈상규、C-반응단백,병통과병원학혹혈청면역학검사명학진단；PCT조환자가측PCT.상규조안조항생소지남진행치료,PCT조근거PCT질량농도지도항생소치료.비교2조적항생소비용급료정、사용솔급림상유효솔화병사솔.PCT조안감염적판정표준분위3개아조:세균감염조、병독감염조화비감염조.채용성조t검험、x2검험、단인소방차분석,최소현저법등통계방법,비교각조염증지표대진단세균감염적개치.PCT조안조예후불동,분위예후량호조화예후불량량조,비교량조간혈청PCT질량농도,평개기여세균감염환자예후적관계.결과 상규조화PCT조항생소적비용급사용솔、료정분별시(3586.5 ± 703.3)원、95.08％、(15.01 ±11.21)d화(1871.2 ±433.5)원、54.60％、(11.22±7.10)d,차이구유통계학의의(P＜0.01)；림상유효솔、병사솔차이무통계학의의(P＞0.05).혈청PCT질량농도재세균감염조(1.12±0.88) ng/ml균고우병독감염조(0.21±0.11) ng/ml화비감염조(0.18±0.13)ng/ml,차이구유통계학의의(P＜0.01)；이후2조적PCT치차이무통계학의의(P＞0.05).PCT진단세균감염적민감성、특이성、양성예측치(PPV)화음성예측치(NPV)균우우기타염증지표.결론 혈청PCT질량농도대급진의사감별진단급성발열적성질、예후우우기타염증지표,대림상합리사용항생소유중요지도의의.
Objective To investigate the clinical value of serum procalcitonin (PCT) in the diagnosis and treatment of the patients with high fever of acute illness.Methods A total of 285 febrile patients suffered from acute illness were divided into the conventional group (n =122) and the PCT group (n =163).The routine blood examination and serum level of C-reactive protein (CRP) detection were carried out for the dignosis of these febrile patiens of two groups,and in addition,serum PCT determination was carried out in the patients of PCT group.The diagnosis was comnfirmed by etiology or immunologic assays.Routine guidelines of administrating antibiotics were used for treatment in the conventional group.Whereas the antibiotic therapy given to patients of PCT group was guided by the serum PCT levels.Two groups were compared in respect of the antibiotics costs,duration of treatment with antibiotics,percentage of patients treated with antibiotics,efficiency of antibiotics treatment and the mortality rate.The patients of PCT group were further divided as per inflammatory markers of bacterial infection into three subgroups,namely bacterial infection group,viral infection group and non-infection group.At last,the relationship between serum PCT level and the prognosis of patients was analyzed.Results The cost of antibiotics,percentage of patients treated with antibiotics,and course of antibiotics treatment were (Y) (3586.5 ± 703.3),95.08％ and (15.01 ± 11.21) days,respectively in conventional group,whereas (Y) (1871.2 ± 433.5),54.60％,(11.22 ±7.10) days in PCT group with statistically significant difference between two groups (P ＜ 0.01),but there were no significant differences in clinical efficiency and mortality between groups (P ＞ 0.05).Serum PCT (1.12 ± 0.88) ng/ml in bacterial infection group was higher than that in both virus infected group (0.21 ± 0.1 1) ng/ml and non-infected group (0.18 ± 0.13) ng/ml.There was no statistics difference in serum PCT level between virus infected group and non-infected group (P ＞ 0.05).The diagnosis of bacterial infection with serum PCT was better than other inflammatory markers because serum PCT had high sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV).Conclusions Serum PCT level was reliable to differentiate the nature of acute infection with high fever and to evaluate the prognosis by emergency physicians.There was an important significance for rational use of antibiotics by the guidance of PCT levels.