中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2013年
7期
615-619
,共5页
石岩%徐英春%芮曦%杜微%王瑶%刘晔
石巖%徐英春%芮晞%杜微%王瑤%劉曄
석암%서영춘%예희%두미%왕요%류엽
肺炎,细菌性%降钙素%蛋白质前体%治疗结果
肺炎,細菌性%降鈣素%蛋白質前體%治療結果
폐염,세균성%강개소%단백질전체%치료결과
Pneumonia,bacterial%Calcitonin%Protein precursors%Treatment outcome
目的 研究血清降钙素原(PCT)变化率在指导重症细菌性肺炎疗效评估中的作用.方法 本研究为前瞻单中心观察性研究.纳入2010年北京协和医院ICU中收治的重症细菌性肺炎患者.入选65例,平均年龄(62±16)岁.诊断为重症社区获得性肺炎5例,院内获得性肺炎32例和呼吸机相关性肺炎28例.入选时临床肺部感染评分(CPIS) 7.9 ±1.8；急性生理及慢性健康状态(APACHE)Ⅱ评分14.5±5.3.有效组44例,失败组21例.在入选时、72 h、第7天、治疗结束时测定血清PCT水平.治疗结束后5d内按照卫生部抗茵药物临床研究指导原则完成疗效评估,分为有效(包括治愈及改善)和失败.采用SPSS13.0进行统计分析.结果 两组患者在入选、72 h、第7天和治疗结束时的PCT及72 h PCT变化率依次为(3.83±2.18)比(4.23 ±2.64) μg/L(t=1.249,P=0.387)、(2.44±1.05)比(3.48±1.75) μg/L (t=-1.959,P=0.045)、(1.15±0.87)比(3.41±1.58) μg/L(t=-2.904.P=0.006)、(0.51 ±0.17)比(2.63±1.08)μg/L(t=-3.772,P=0.000)及(32.5 ±12.4)％vs(14.5 ±7.1)％(t=-2.376,P=0.009).72 h PCT变化率预测疗效的受试者工作特征曲线下面积AUC为0.823 (P =0.002),白细胞、中性粒细胞百分比、体温、72 h PCT绝对值预测疗效的AUC依次为0.575,0.543,0.521,0.597(P＞0.05).多元回归分析显示72 h PCT变化率＜30.8％(OR 15.2,95％CCI3.3 ～21.7,P=0.01)是影响疗效的独立危险因素之一.PCT变化率(下降＞30.8％)联合CPIS(＜6分)预测疗效的AUC为0.910,敏感度85.2％,特异度92.5％.结论 72 h PCT变化率可指导重症细菌性肺炎早期治疗效果评估,联合CPIS可进一步提高其预测价值.
目的 研究血清降鈣素原(PCT)變化率在指導重癥細菌性肺炎療效評估中的作用.方法 本研究為前瞻單中心觀察性研究.納入2010年北京協和醫院ICU中收治的重癥細菌性肺炎患者.入選65例,平均年齡(62±16)歲.診斷為重癥社區穫得性肺炎5例,院內穫得性肺炎32例和呼吸機相關性肺炎28例.入選時臨床肺部感染評分(CPIS) 7.9 ±1.8；急性生理及慢性健康狀態(APACHE)Ⅱ評分14.5±5.3.有效組44例,失敗組21例.在入選時、72 h、第7天、治療結束時測定血清PCT水平.治療結束後5d內按照衛生部抗茵藥物臨床研究指導原則完成療效評估,分為有效(包括治愈及改善)和失敗.採用SPSS13.0進行統計分析.結果 兩組患者在入選、72 h、第7天和治療結束時的PCT及72 h PCT變化率依次為(3.83±2.18)比(4.23 ±2.64) μg/L(t=1.249,P=0.387)、(2.44±1.05)比(3.48±1.75) μg/L (t=-1.959,P=0.045)、(1.15±0.87)比(3.41±1.58) μg/L(t=-2.904.P=0.006)、(0.51 ±0.17)比(2.63±1.08)μg/L(t=-3.772,P=0.000)及(32.5 ±12.4)％vs(14.5 ±7.1)％(t=-2.376,P=0.009).72 h PCT變化率預測療效的受試者工作特徵麯線下麵積AUC為0.823 (P =0.002),白細胞、中性粒細胞百分比、體溫、72 h PCT絕對值預測療效的AUC依次為0.575,0.543,0.521,0.597(P＞0.05).多元迴歸分析顯示72 h PCT變化率＜30.8％(OR 15.2,95％CCI3.3 ～21.7,P=0.01)是影響療效的獨立危險因素之一.PCT變化率(下降＞30.8％)聯閤CPIS(＜6分)預測療效的AUC為0.910,敏感度85.2％,特異度92.5％.結論 72 h PCT變化率可指導重癥細菌性肺炎早期治療效果評估,聯閤CPIS可進一步提高其預測價值.
목적 연구혈청강개소원(PCT)변화솔재지도중증세균성폐염료효평고중적작용.방법 본연구위전첨단중심관찰성연구.납입2010년북경협화의원ICU중수치적중증세균성폐염환자.입선65례,평균년령(62±16)세.진단위중증사구획득성폐염5례,원내획득성폐염32례화호흡궤상관성폐염28례.입선시림상폐부감염평분(CPIS) 7.9 ±1.8；급성생리급만성건강상태(APACHE)Ⅱ평분14.5±5.3.유효조44례,실패조21례.재입선시、72 h、제7천、치료결속시측정혈청PCT수평.치료결속후5d내안조위생부항인약물림상연구지도원칙완성료효평고,분위유효(포괄치유급개선)화실패.채용SPSS13.0진행통계분석.결과 량조환자재입선、72 h、제7천화치료결속시적PCT급72 h PCT변화솔의차위(3.83±2.18)비(4.23 ±2.64) μg/L(t=1.249,P=0.387)、(2.44±1.05)비(3.48±1.75) μg/L (t=-1.959,P=0.045)、(1.15±0.87)비(3.41±1.58) μg/L(t=-2.904.P=0.006)、(0.51 ±0.17)비(2.63±1.08)μg/L(t=-3.772,P=0.000)급(32.5 ±12.4)％vs(14.5 ±7.1)％(t=-2.376,P=0.009).72 h PCT변화솔예측료효적수시자공작특정곡선하면적AUC위0.823 (P =0.002),백세포、중성립세포백분비、체온、72 h PCT절대치예측료효적AUC의차위0.575,0.543,0.521,0.597(P＞0.05).다원회귀분석현시72 h PCT변화솔＜30.8％(OR 15.2,95％CCI3.3 ～21.7,P=0.01)시영향료효적독립위험인소지일.PCT변화솔(하강＞30.8％)연합CPIS(＜6분)예측료효적AUC위0.910,민감도85.2％,특이도92.5％.결론 72 h PCT변화솔가지도중증세균성폐염조기치료효과평고,연합CPIS가진일보제고기예측개치.
Objective The aim of this study is to define if early change ofprocalcitonin (PCT) may inform about the efficacy evaluation of severe bacterial pneumonia.Methods A prospective,single-center,observational study was conducted in patients with severe bacterial pneumonia admitted to ICU in 2010 years.PCT samples were collected in baseline,72 hours,7 days and the ending in the duration of therapy.The efficacy evaluation was assessed at the end of treatment 5 days after and divided into the efficacy group and nonefficacy group according to the guiding principle of clinical research on antibacterial drugs by the Ministry of Health.Sixty-five patients with a mean age of (62.1 ± 15.9) years were evaluated.Five patients were severe community acquired pneumonia,32 patients nosocomial pneumonia and 28 patients ventilator associated pneumonia.The clinical pulmonary infection score(CPIS) was 7.9 ± 1.8 ;APACHE Ⅱ score was 14.5 ±5.3.There were 44 patients as the efficacy group and 21 patients as the nonefficacy group.SPSS13.0 was used to analyse the results.Results The PCT levels between efficacy group and nonefficacy group were (3.83 ±2.18)vs(4.23 ±2.64) μg,/L (t =1.249,P =0.387),(2.44 ± 1.05)vs(3.48 ± 1.75) μg/L(t=-1.959,P=0.045),(1.15 ±0.87) vs (3.41 ±1.58) μg/L (t=-2.904,P=0.006),and (0.51 ±0.17) vs (2.63 ±1.08) μg/L (t=-3.772,P =0.000) in baseline,72 hours,7 days and the ending in the duration of therapy.The change of PCT within the first 72 hours were (32.5 ± 12.4)％ vs (14.5 ± 7.1) ％.The area under receiver operating characteristics curve (AUC) of prediction clinical efficacy of the change of PCT within the first 72 hours was 0.823 (P =0.002),the AUC of white blood cell,the neuter granulocyte percentage,body temperature and PCT level within 72 hours were 0.575,0.543,0.521,0.597,respectively (P ＞ 0.05).In multivariate analyses,the change of PCT ＜ 30.8％ (odds ratio,15.2,95％ confidence interval,3.3-21.7,P =0.01) was independent risk factors of effect predictor.The changes of PCT within the first 72 hours (＞30.8％) combined with CPIS(＜6) were the best performance to predict clinical efficacy with a AUC of 0.910,sensitivity of 85.2％ and specificity of 92.5％.Conclusions The change of PCT within the first 72 hours can be used early to evaluate the effect in bacterial pneumonia.Especially,combined with CPIS can further improve the prediction value.
