CAJ | 학술논문

目的研究不伴感染的急性脑卒中患者72h内降钙素原(PCT)的动态变化,进一步明确PCT在急性脑卒中后早期感染诊断中的价值. 方法选择南方医院神经内科自2012年7月至2013年1月收治的发病24 h内的不伴感染的急性脑卒中患者41例,分别于发病24 h、48 h和72 h检测血清PCT和C-反应蛋白(CRP)浓度,比较各时间点PCT、CRP浓度与各自正常上限的差异及达峰比例以及变化趋势. 结果急性脑卒中后24 h、48 h、72 h PCT浓度中位数(四分位数)分别为[0.050(0.040,0.080)] ng/mL、[0.060(0.036,0.095)] ng/mL、[0.051 (0.040,0.079)] ng/mL,均较正常上限(0.05 ng/mL)明显升高,差异均有统计学意义(P＜0.05).急性脑卒中后24 h、48 h CRP浓度中位数(四分位数)分别为[3.200(1.1 00,5.000)] mg/L、[4.300(1.700,9.900)] mg/L,与正常上限(5.0 mg/L)相比差异无统计学意义(P＞0.05); 72h CRP浓度中位数(四分位数)[5.300(2.500,15.550) mg/L]较正常上限明显升高,差异有统计学意义(P＜0.05).PCT浓度在24 h达峰的比例最高(22例,53.67％),而CRP浓度在72 h达峰的比例最高(26例,63.41％).急性脑卒中后72 h内PCT浓度有逐渐下降趋势,而CRP浓度有逐渐上升趋势. 结论 PCT在急性脑卒中后72 h内可升高,故利用PCT判断急性脑卒中后早期感染时,需考虑脑卒中本身对PCT的影响.并且,PCT较CRP达峰早、下降快,在判断急性脑卒中患者早期合并感染方面可能更有价值.
목적 연구불반감염적급성뇌졸중환자72h내강개소원(PCT)적동태변화,진일보명학PCT재급성뇌졸중후조기감염진단중적개치. 방법 선택남방의원신경내과자2012년7월지2013년1월수치적발병24 h내적불반감염적급성뇌졸중환자41례,분별우발병24 h、48 h화72 h검측혈청PCT화C-반응단백(CRP)농도,비교각시간점PCT、CRP농도여각자정상상한적차이급체봉비례이급변화추세. 결과 급성뇌졸중후24 h、48 h、72 h PCT농도중위수(사분위수)분별위[0.050(0.040,0.080)] ng/mL、[0.060(0.036,0.095)] ng/mL、[0.051 (0.040,0.079)] ng/mL,균교정상상한(0.05 ng/mL)명현승고,차이균유통계학의의(P＜0.05).급성뇌졸중후24 h、48 h CRP농도중위수(사분위수)분별위[3.200(1.1 00,5.000)] mg/L、[4.300(1.700,9.900)] mg/L,여정상상한(5.0 mg/L)상비차이무통계학의의(P＞0.05); 72h CRP농도중위수(사분위수)[5.300(2.500,15.550) mg/L]교정상상한명현승고,차이유통계학의의(P＜0.05).PCT농도재24 h체봉적비례최고(22례,53.67％),이CRP농도재72 h체봉적비례최고(26례,63.41％).급성뇌졸중후72 h내PCT농도유축점하강추세,이CRP농도유축점상승추세. 결론 PCT재급성뇌졸중후72 h내가승고,고이용PCT판단급성뇌졸중후조기감염시,수고필뇌졸중본신대PCT적영향.병차,PCT교CRP체봉조、하강쾌,재판단급성뇌졸중환자조기합병감염방면가능경유개치.
Objective To investigate the dynamic changes ofprocalcitonin (PCT) within 72 h of acute stroke without infection and explore the value of PCT in diagnosis of bacterial infection in the early stage of acute stroke.Methods Forty-one patients with acute stroke within 24 hours of symptom onset,admitted to our hospital from July 2012 to January 2013,were enrolled in our study.The concentrations of PCT and C-reactive protein (CRP) in the serum were measured,respectively,at 24,48 and 72 h after symptom onset.At each time point,the PCT and CRP values were compared with the upper value of normal ranges of PCT and CRP,respectively.Results The median (quartiles) PCT concentrations at 24,48 and 72 h after stroke onset were,respectively,(0.050 [0.040,0.080]) ng/mL,(0.060 [0.036,0.095]) ng/mL and [0.051 (0.040,0.079)] ng/mL,which were significantly different as compared with that of the upper value of normal range (0.05 ng/mL,P＜0.05).The median (quartiles) CRP concentrations at 24 and 48 h after stroke onset were,respectively,[3.200 (1.100,5.000)] mg/L and [4.300(1.700,9.900)] mg/L,showing no significant difference with the upper value of normal range (5.0 mg/L,P＞0.05); however,the mean CRP concentration at 72 after stroke onset was [5.300 (2.500,15.550) mg/L],enjoying significant difference as compared with the upper value of normal range (P＜0.05).Most of the patients (22 patients,53.67％) had a peak level of PCT at 24 h,while most of them (26,63.41％) had a peak level of CRP at 72 h.The concentration of PCT increased within 24 h after symptom onset,but declined in the following 72 h; in contrast,the concentration of CRP continuously increased in the first 72 h of symptom onset.Conclusions PCT concentrations may increase in the first 72 h after acute stroke,therefore,when using PCT in diagnosis of bacterial infection in the early stage of acute stroke,the influence of elevating PCT concentrations by stroke itself should be considered.But PCT usually reaches its peak level earlier than CRP and returns to normal range faster than CRP,which may be more valuable than CRP in diagnosis of bacterial infection in the early stage of acute stroke.