临床肺科杂志
臨床肺科雜誌
림상폐과잡지
JOUNAL OF CLINICAL PULMONARY MEDICINE
2015年
2期
290-294
,共5页
社区获得性感染%肺炎%降钙素原%预后%危险因素%严重程度
社區穫得性感染%肺炎%降鈣素原%預後%危險因素%嚴重程度
사구획득성감염%폐염%강개소원%예후%위험인소%엄중정도
community-acquired infections%pneumonia%procalcitonin%prognosis%risk factors%severity
目的：分析血清降钙素原（PCT）水平对老年重症社区获得性肺炎（Community-acquired pneumo-nia，CAP）预后及病情严重程度的预测价值。方法以我院住院的老年重症CAP患者87例为研究对象，收集其临床资料，根据入院后28天生存情况分为死亡组和存活组。并按CURB、PSI评分标准分组，比较不同分组间入院第1天、第4天PCT水平（PCT1、PCT4）及其变化水平（PCT4-1）的差异。分析死亡组与存活组在PCT1、PCT4、PCT4-1、CURB≥3分、PSI≥4级5项因素方面的差异，在其中筛选死亡的独立危险因素。用受试者工作特征曲线（ROC曲线）下面积（AUC）评估各项独立危险因素单独及联合应用预测28天生存情况的效能，并对各项因素的预测效能进行比较。结果死亡组PCT4显著高于存活组。死亡组PCT4-1水平显著高于存活组，死亡组为正值，存活组为负值，即死亡组PCT4较PCT1在升高，而存活组已在下降。PCT1、PCT4水平在CURB≥3组显著高于CURB＜3组。PCT4、PCT4-1、CURB≥3分三项因素为死亡的独立危险因素，其预测死亡的AUC值分别为0.8768、0.7995、0.7054，PCT4、PCT4-1 AUC值无显著差异，但PCT4的AUC值显著高于CURB≥3分，三项因素合并的AUC值为0.853，显著高于CURB≥3分，其预测死亡的敏感度为81.1％，特异度为90.0％。结论动态监测血清PCT水平，对判断老年重症CAP的预后及病情严重程度有一定价值。
目的：分析血清降鈣素原（PCT）水平對老年重癥社區穫得性肺炎（Community-acquired pneumo-nia，CAP）預後及病情嚴重程度的預測價值。方法以我院住院的老年重癥CAP患者87例為研究對象，收集其臨床資料，根據入院後28天生存情況分為死亡組和存活組。併按CURB、PSI評分標準分組，比較不同分組間入院第1天、第4天PCT水平（PCT1、PCT4）及其變化水平（PCT4-1）的差異。分析死亡組與存活組在PCT1、PCT4、PCT4-1、CURB≥3分、PSI≥4級5項因素方麵的差異，在其中篩選死亡的獨立危險因素。用受試者工作特徵麯線（ROC麯線）下麵積（AUC）評估各項獨立危險因素單獨及聯閤應用預測28天生存情況的效能，併對各項因素的預測效能進行比較。結果死亡組PCT4顯著高于存活組。死亡組PCT4-1水平顯著高于存活組，死亡組為正值，存活組為負值，即死亡組PCT4較PCT1在升高，而存活組已在下降。PCT1、PCT4水平在CURB≥3組顯著高于CURB＜3組。PCT4、PCT4-1、CURB≥3分三項因素為死亡的獨立危險因素，其預測死亡的AUC值分彆為0.8768、0.7995、0.7054，PCT4、PCT4-1 AUC值無顯著差異，但PCT4的AUC值顯著高于CURB≥3分，三項因素閤併的AUC值為0.853，顯著高于CURB≥3分，其預測死亡的敏感度為81.1％，特異度為90.0％。結論動態鑑測血清PCT水平，對判斷老年重癥CAP的預後及病情嚴重程度有一定價值。
목적：분석혈청강개소원（PCT）수평대노년중증사구획득성폐염（Community-acquired pneumo-nia，CAP）예후급병정엄중정도적예측개치。방법이아원주원적노년중증CAP환자87례위연구대상，수집기림상자료，근거입원후28천생존정황분위사망조화존활조。병안CURB、PSI평분표준분조，비교불동분조간입원제1천、제4천PCT수평（PCT1、PCT4）급기변화수평（PCT4-1）적차이。분석사망조여존활조재PCT1、PCT4、PCT4-1、CURB≥3분、PSI≥4급5항인소방면적차이，재기중사선사망적독립위험인소。용수시자공작특정곡선（ROC곡선）하면적（AUC）평고각항독립위험인소단독급연합응용예측28천생존정황적효능，병대각항인소적예측효능진행비교。결과사망조PCT4현저고우존활조。사망조PCT4-1수평현저고우존활조，사망조위정치，존활조위부치，즉사망조PCT4교PCT1재승고，이존활조이재하강。PCT1、PCT4수평재CURB≥3조현저고우CURB＜3조。PCT4、PCT4-1、CURB≥3분삼항인소위사망적독립위험인소，기예측사망적AUC치분별위0.8768、0.7995、0.7054，PCT4、PCT4-1 AUC치무현저차이，단PCT4적AUC치현저고우CURB≥3분，삼항인소합병적AUC치위0.853，현저고우CURB≥3분，기예측사망적민감도위81.1％，특이도위90.0％。결론동태감측혈청PCT수평，대판단노년중증CAP적예후급병정엄중정도유일정개치。
Objective To investigate the prognostic value of PCT in elderly patients with severe community-acquired pneumonia (CAP).Methods 87 elderly patients with severe CAP were examined.Their clinical data were collected and they were divided into different groups by CURB,PSI evaluation score and 28-d clinical outcome. The difference of PCT levels was compared within 1 day (PCT1 )and 4 days (PCT4)after admission and the value of PCT4 minus PCT1 (PCT4-1 )was also recorded in different groups.The independent risk factors associated with death were analyzed.Their prediction performance for predicting 28-day survival was compared.Results The levels of PCT4 and PCT4-1 were significantly higher in the death group than in the survival group.The levels of PCT1 and PCT4 were higher in the CURB≥3 group than in the CURB<3 group.PCT4,PCT4-1 and CURB≥3 were independ-ent risk factors associated with death (P<0.05),and its value of AUC for predicting death was 0.8768,0.7995 and 0.7054 respectively.The AUC of PCT4 was significantly larger than that of CURB≥3. The AUC of PCT4,PCT4-1 and CURB≥3 together was 0.853.Its sensitivity of predicting death was 81.1% and its specificity was 90.0%. Conclusion The dynamic monitoring of PCT has value of predicting 28-day survival and helps physicians evaluate the severity of illness accurately in elderly patients with severe CAP.
