中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2011年
12期
1069-1072
,共4页
邓锐%尚颖%叶阮健%张荣葆%高占成
鄧銳%尚穎%葉阮健%張榮葆%高佔成
산예%상영%협원건%장영보%고점성
呼吸道感染%降钙素%蛋白质前体
呼吸道感染%降鈣素%蛋白質前體
호흡도감염%강개소%단백질전체
Respiratory tract infections%Calcitonin%Protein precursors
目的 评价降钙素原在成人下呼吸道感染中的诊断价值.方法 收集2008年7-12月北京大学人民医院的疑似下呼吸道感染的成人患者97例,分为下呼吸道感染合并脓毒症组、医院获得性肺炎组、社区获得性肺炎组、慢性阻塞性肺病急性加重组、其他下呼吸道感染组以及非感染性疾病组.记录各组患者的外周血血常规、红细胞沉降率、C反应蛋白、降钙素原、痰细菌培养、血培养等资料,所有病例均进行APACHEⅡ评分.降钙素原的检测采用荧光免疫夹心法.结果 下呼吸道感染合并脓毒症组、医院获得性肺炎组、社区获得性肺炎组、慢性阻塞性肺病急性加重组、其他下呼吸道感染组、非感染性疾病组降钙素原水平分别为10.1(0.7 ～37.0)、0.3(0.1 ～0.8)、0.2(0.1 ～0.9)、0.2(0.1～0.4)、0.3(0.1 ～0.5)、0.1(0.1 ～0.2)mg/L,差异有统计学意义(H=19.898,P＜0.01)；两两比较显示,下呼吸道感染合并脓毒症组、医院获得性肺炎组、社区获得性肺炎组、其他下呼吸道感染组降钙素原水平均高于非感染性疾病组(U值分别为0、18.000、81.000、20.000,P值均＜0.01)；且下呼吸道感染合并脓毒症组降钙素原水平显著高于其余感染组(U值分别为11.000、45.000、3.000、4.500,P均＜0.01).对细菌培养阳性患者的降钙素原和APACHEⅡ评分进行Pearson相关分析,r为0.499.取0.5 mg/L为临界值,降钙素原诊断下呼吸道感染的敏感度为32.6％,特异度为100％；而临界值为0.235 mg/L时,敏感度为53.9％,特异度为100％,诊断正确率为53.9％.结论 降钙素原在成人下呼吸道感染的诊断中具有一定价值,尤其是合并脓毒症时.适当下调降钙素原临界值可以进一步提高其诊断敏感度.
目的 評價降鈣素原在成人下呼吸道感染中的診斷價值.方法 收集2008年7-12月北京大學人民醫院的疑似下呼吸道感染的成人患者97例,分為下呼吸道感染閤併膿毒癥組、醫院穫得性肺炎組、社區穫得性肺炎組、慢性阻塞性肺病急性加重組、其他下呼吸道感染組以及非感染性疾病組.記錄各組患者的外週血血常規、紅細胞沉降率、C反應蛋白、降鈣素原、痰細菌培養、血培養等資料,所有病例均進行APACHEⅡ評分.降鈣素原的檢測採用熒光免疫夾心法.結果 下呼吸道感染閤併膿毒癥組、醫院穫得性肺炎組、社區穫得性肺炎組、慢性阻塞性肺病急性加重組、其他下呼吸道感染組、非感染性疾病組降鈣素原水平分彆為10.1(0.7 ～37.0)、0.3(0.1 ～0.8)、0.2(0.1 ～0.9)、0.2(0.1～0.4)、0.3(0.1 ～0.5)、0.1(0.1 ～0.2)mg/L,差異有統計學意義(H=19.898,P＜0.01)；兩兩比較顯示,下呼吸道感染閤併膿毒癥組、醫院穫得性肺炎組、社區穫得性肺炎組、其他下呼吸道感染組降鈣素原水平均高于非感染性疾病組(U值分彆為0、18.000、81.000、20.000,P值均＜0.01)；且下呼吸道感染閤併膿毒癥組降鈣素原水平顯著高于其餘感染組(U值分彆為11.000、45.000、3.000、4.500,P均＜0.01).對細菌培養暘性患者的降鈣素原和APACHEⅡ評分進行Pearson相關分析,r為0.499.取0.5 mg/L為臨界值,降鈣素原診斷下呼吸道感染的敏感度為32.6％,特異度為100％；而臨界值為0.235 mg/L時,敏感度為53.9％,特異度為100％,診斷正確率為53.9％.結論 降鈣素原在成人下呼吸道感染的診斷中具有一定價值,尤其是閤併膿毒癥時.適噹下調降鈣素原臨界值可以進一步提高其診斷敏感度.
목적 평개강개소원재성인하호흡도감염중적진단개치.방법 수집2008년7-12월북경대학인민의원적의사하호흡도감염적성인환자97례,분위하호흡도감염합병농독증조、의원획득성폐염조、사구획득성폐염조、만성조새성폐병급성가중조、기타하호흡도감염조이급비감염성질병조.기록각조환자적외주혈혈상규、홍세포침강솔、C반응단백、강개소원、담세균배양、혈배양등자료,소유병례균진행APACHEⅡ평분.강개소원적검측채용형광면역협심법.결과 하호흡도감염합병농독증조、의원획득성폐염조、사구획득성폐염조、만성조새성폐병급성가중조、기타하호흡도감염조、비감염성질병조강개소원수평분별위10.1(0.7 ～37.0)、0.3(0.1 ～0.8)、0.2(0.1 ～0.9)、0.2(0.1～0.4)、0.3(0.1 ～0.5)、0.1(0.1 ～0.2)mg/L,차이유통계학의의(H=19.898,P＜0.01)；량량비교현시,하호흡도감염합병농독증조、의원획득성폐염조、사구획득성폐염조、기타하호흡도감염조강개소원수평균고우비감염성질병조(U치분별위0、18.000、81.000、20.000,P치균＜0.01)；차하호흡도감염합병농독증조강개소원수평현저고우기여감염조(U치분별위11.000、45.000、3.000、4.500,P균＜0.01).대세균배양양성환자적강개소원화APACHEⅡ평분진행Pearson상관분석,r위0.499.취0.5 mg/L위림계치,강개소원진단하호흡도감염적민감도위32.6％,특이도위100％；이림계치위0.235 mg/L시,민감도위53.9％,특이도위100％,진단정학솔위53.9％.결론 강개소원재성인하호흡도감염적진단중구유일정개치,우기시합병농독증시.괄당하조강개소원림계치가이진일보제고기진단민감도.
Objective To investigate the value of serum procalcitonin (PCT) in diagnosing lower respiratory tract infection (LRTI) in adult.Methods In a retrospective study,97 patients were enrolled,who admitted into Peking University People's Hospital with suspected LRTI from July to December 2008.During analysis,the subjects are categorized into groups of LRTI with sepsis,hospital-acquired pneumonia(HAP),community-acquired pneumonia(CAP),acute exacerbation of chronic obstructive lung disease (AECOPD),other LRTI and non-infectious diseases.In these cases,the following parameters were assessed regularly,such as white blood cell count,erythrocyte sedimentation rate( ESR),C-reactive protein (CRP),PCT,bacterial culture of both sputum and blood,and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score.PCT levels were determined using antibody-coated tubes as a complete diagnostic-kit (LUMI test Pro-Calcitonin) in a Luminometer.Results Mean PCT levels in groups of LRTI with sepsis, hospital-acquired pneumonia ( HAP ), community-acquired pneumonia ( CAP ), acute exacerbation of chronic obstructive lung disease( AECOPD),other LRTI,non-infectious diseases were 10.1 (0.7 -37.0),0.3(0.1 -0.8),0.2(0.1 -0.9),0.2(0.1 -0.4),0.3(0.1 -0.5),0.1 (0.1 -0.2) mg/L,respectively.There were statistical differences between these groups (H =19.898,P ＜ 0.01 ).And the PCT levels in groups of LRTI with sepsis,HAP,CAP,AECOPD,other LRTI were higher than group of non-infectious diseases ( U values were 0,18.000,81.000,20.000,all P ＜ 0.01 ).Patients with sepsis exhibited strongly higher PCT levels than patients with other lung diseases ( U values were 11.000,45.000,3.000,4.500,all P ＜ 0.01 ).Pearson correlation analysis of PCT levels with positive bacterial cultures and APACHE Ⅱ score was performed ( r =0.449).ROC analysis revealed that optimal discrimination between LRTI and non-infectious diseases could be performed at the cut-off point of 0.5 mg/L with a sensitivity of 32.6％ and specificity of 100％,while at a suggested cut-off point of 0.235 mg/L with a sensitivity of 53.9％ and specificity of 100％.Conclusions PCT is a more useful parameter for diagnosing lower respiratory tract infections( especially for those with sepsis) than other infectious markers such as CRP,ESR and white blood cell count.The sensitivity of PCT could be elevated with a reduction of the cut-off level.
