CAJ | 학술논문

目的：探讨降钙素原（PCT）、C‐反应蛋白（CRP）以及临床肺部感染评分（CPIS）对呼吸机相关性肺炎（VAP）患者的诊断效果，为临床治疗提供参考依据。方法2013年1月－2014年6月96例行机械通气患者根据是否确诊VAP分为确诊组45例和未确诊组51例，监测入组当日和确诊VAP当日血清PCT和CRP浓度；对比临床各项指标，采用SPSS17．0软件进行统计处理。结果两组患者的体温、氧合指数、白细胞数目、CPIS评分、PCT、CRP、入组前服用抗菌药物差异无统计学意义，APACHEⅡ和SOFA评分、入住ICU时间、机械通气时间差异有统计学意义（P＜0．05）；PCT对VAP的诊断阈值为0．7ng／ml、敏感度为77．3％、特异度为64．0％；CRP对VAP的诊断阈值为54．0mg／L，敏感度为51．2％、特异度为64．7％。结论PCT、CRP和CPIS评分之间无显著相关性，CRP对VAP早期诊断无明显价值，PCT对VAP早期诊断具有一定价值，简化CPIS评分对VAP早期诊断具有较好的诊断价值。
목적：탐토강개소원（PCT）、C‐반응단백（CRP）이급림상폐부감염평분（CPIS）대호흡궤상관성폐염（VAP）환자적진단효과，위림상치료제공삼고의거。방법2013년1월－2014년6월96례행궤계통기환자근거시부학진VAP분위학진조45례화미학진조51례，감측입조당일화학진VAP당일혈청PCT화CRP농도；대비림상각항지표，채용SPSS17．0연건진행통계처리。결과량조환자적체온、양합지수、백세포수목、CPIS평분、PCT、CRP、입조전복용항균약물차이무통계학의의，APACHEⅡ화SOFA평분、입주ICU시간、궤계통기시간차이유통계학의의（P＜0．05）；PCT대VAP적진단역치위0．7ng／ml、민감도위77．3％、특이도위64．0％；CRP대VAP적진단역치위54．0mg／L，민감도위51．2％、특이도위64．7％。결론PCT、CRP화CPIS평분지간무현저상관성，CRP대VAP조기진단무명현개치，PCT대VAP조기진단구유일정개치，간화CPIS평분대VAP조기진단구유교호적진단개치。
OBJECTIVE To explore the effect of procalcitonin (PCT ) and C‐reactive protein (CRP) and clinical pul‐monary infection scores (CPIS) in the diagnosis of ventilator associated pneumonia (VAP) so as to provide refer‐ences for clinical treatments .METHODS Totally 96 patients with mechanical ventilation in our hospital from Jan . 2013 to Jan .2014 were divided into confirmed group with 45 cases and undiagnosed group with 51 cases according to the diagnosis of VAP .PCT and CRP concentration were monitored on the day that they were included and on the day that they were diagnosed with VAP .Various indicators were compared .All data were analyzed by SPSS 17 .0 software .RESULTS The differences between the two groups'temperature ,oxygenation index ,number of white blood cells ,CPIS scores ,PCT ,CRP ,and whether took antibiotics before entering the group were all not significant .There were significance between the two groups with APACHE scores and SOFA scores ,ICU stay and mechanical ventilation time (P<0 .05) .Diagnostic threshold of VAP to PCT was 0 .7 ng/ml ,the sensitivity was 77 .3% ,specificity was 64 .0% ;diagnosis threshold of CRP to VAP was 54 .0 mg/L ,the sensitivity was 51 .2% ,specificity was 64 .7% .CONCLUSION There are no significant correlations between PCT ,CRP and CPIS scores ,no significant diagnosis value of CRP level to VAP .PCT has a certain value in the diagnosis of VAP .Sim‐plified CPIS scores can better diagnose VAP in the early period .