CAJ | 학술논문

目的通过对社区获得性肺炎(community acquired pneumonia,CAP)婴幼儿联合检测痰液及血清降钙素原(procalcitonin,PCT),探讨其在鉴别婴幼儿CAP病原学性质方面的意义.方法 2010年8月至2012年9月我院儿科病房婴幼儿CAP病原学诊断明确的435例患儿,根据病原性质分为3组:细菌感染组243例(混合细菌感染归入此组),病毒感染组106例,肺炎支原体感染组86例.比较分析痰液及血清PCT水平,同时检测血常规白细胞、C反应蛋白.结果细菌感染组CAP患儿痰液PCT(8.44±1.08) ng/ml,明显高于病毒感染组(0.32-±0.12) ng/ml和支原体感染组(0.24 ±0.17) ng/ml,差异有统计学意义(F=765.03,P＜0.01);血清PCT检测水平细菌感染组(6.69±1.36) ng/ml,亦高于病毒感染组(0.37±0.22) ng/ml及支原体感染组(0.42±0.28) ng/ml,差异有统计学意义(F=240.46,P＜0.01);而病毒感染组与支原体感染组间痰液PCT、血清PCT比较差异无统计学意义(P＞0.05).3组患儿血常规白细胞、C反应蛋白水平比较差异无统计学意义(P＞0.05).以痰液、血清PCT＞0.5 ng/ml为临界值,细菌感染组痰液、血清PCT阳性率比较差异有统计学意义(86.83％ vs 73.66％,x2=13.92,P＜0.05).痰液、血清PCT诊断婴幼儿细菌性CAP的敏感性分别为86.83％和73.66％,特异性分别为86.98％和88.54％,联合检测痰夜、血清PCT的敏感性、特异性分别为72.02％和94.27％.结论联合检测痰液及血清PCT,对明确婴幼儿CAP病原体性质更具临床价值.
목적 통과대사구획득성폐염(community acquired pneumonia,CAP)영유인연합검측담액급혈청강개소원(procalcitonin,PCT),탐토기재감별영유인CAP병원학성질방면적의의.방법 2010년8월지2012년9월아원인과병방영유인CAP병원학진단명학적435례환인,근거병원성질분위3조:세균감염조243례(혼합세균감염귀입차조),병독감염조106례,폐염지원체감염조86례.비교분석담액급혈청PCT수평,동시검측혈상규백세포、C반응단백.결과 세균감염조CAP환인담액PCT(8.44±1.08) ng/ml,명현고우병독감염조(0.32-±0.12) ng/ml화지원체감염조(0.24 ±0.17) ng/ml,차이유통계학의의(F=765.03,P＜0.01);혈청PCT검측수평세균감염조(6.69±1.36) ng/ml,역고우병독감염조(0.37±0.22) ng/ml급지원체감염조(0.42±0.28) ng/ml,차이유통계학의의(F=240.46,P＜0.01);이병독감염조여지원체감염조간담액PCT、혈청PCT비교차이무통계학의의(P＞0.05).3조환인혈상규백세포、C반응단백수평비교차이무통계학의의(P＞0.05).이담액、혈청PCT＞0.5 ng/ml위림계치,세균감염조담액、혈청PCT양성솔비교차이유통계학의의(86.83％ vs 73.66％,x2=13.92,P＜0.05).담액、혈청PCT진단영유인세균성CAP적민감성분별위86.83％화73.66％,특이성분별위86.98％화88.54％,연합검측담야、혈청PCT적민감성、특이성분별위72.02％화94.27％.결론 연합검측담액급혈청PCT,대명학영유인CAP병원체성질경구림상개치.
Objective To evaluate the effects of combined detection of sputum and serum procalcitonin (PCT) to identify the etiology of community acquired pneumonia(CAP) in infants.Methods Retrospective analysis from August 2010 to September 2012 enrolled 435 patients with definitely etiological diagnosis of CAP.The all cases were divided into three groups according to the etiological diagnosis:243 cases of bacterial infection group(including mixed bacterial infection),106 cases of viral infection group,and 86 cases of mycoplasma infection group.Sputum and serum PCT levels in all cases were detected,with simultaneous detection of blood leukocytes,C-reactive protein levels.Results Sputum PCT level of bacterial infection group [(8.44 ± 1.08) ng/ml] was significantly higher than viral infection group [(0.32 ±0.12) ng/ml] and mycoplasma infection group [(0.24 ± 0.17) ng/ml],which showed statistically significant difference (F =765.03,P ＜0.01).Serum PCT level of bacterial infection group [(6.69 ± 1.36) ng/ml] was also higher than viral infection group [(0.37 ± 0.22) ng/ml] and mycoplasma infection group [(0.42 ± 0.28) ng/ml],the difference of which was statistically significant (F =240.46,P ＜ 0.01).Meanwhile between the viral infection group and mycoplasma infection group,sputum PCT and serum PCT showed no significant difference (P ＞ 0.05).The levels of blood leukocytes and C-reactive protein among 3 groups showed no statistically significant difference(P ＞ 0.05).As the critical value of the PCT ＞ 0.5ng/ml,the positive rates of sputum and serum PCT were significant difference in bacterial infection group (86.83％ vs 73.66％,x2 =13.92,P ＜0.05).The sensitivity of diagnosing bacterial CAP by sputum and serum PCT levels were 86.83％ and 73.66％,the specificity were 86.98％ and 88.54％,respectively.The sensitivity and specificity of combined detection sputum and serum PCT were 72.02％ and 94.27％.Conclusion Combined detection of sputum and serum PCT has clinical value and efficiency in pathogen identification of CAP.