降钙素原对急性心肌梗死患者心功能不全与肺部感染的鉴别诊断价值
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摘要
目的探讨血清降钙素原(PCT)对急性心肌梗死(AMI)患者心功能不全与合并肺部感染的鉴别诊断价值。方法应用荧光酶联免疫技术测定70例AMI心功能不全合并肺部感染者(感染组)及72例非感染者(对照组)的PCT,同时测定患者血常规、B型钠尿肽前体、C反应蛋白(CRP)、心脏彩超及肺部CT或胸部X线平片;应用ROC曲线评价检测指标诊断效能。结果白细胞数(WBC)、CRP、PCT感染组与对照组阳性率分别为(91.4%vs 77.8%)、(65.7%vs 38.9%)、(88.6%vs 8.3%)。PCT的敏感性为82.9%,特异性94.4%,诊断价值最大。结论 AMI出现咳嗽、气喘及肺部罗音时,PCT可作为早期快速鉴别心功能不全与肺部感染的实验室指标,指导抗生素合理使用。
Objective To investigate the effects of serum procalcitonin in acute myocardial infarction(AMI)patients with heart failure and pulmonary infection of the differential diagnosis value.Methods The serum PCT of two groups of patients were measured with the fluorescent enzyme immunoassay technique.One of the two groups was 70 cases of AMI patients with heart failure and pulmonary infection(infection group),and the other group was 72 cases of AMI with heart failure(control group).Simultaneous determination of blood routine,NT-proBNP and C-reactive protein(CRP),echocardiography and pulmonary CT image or chest X-ray plain film.application of receiver operating characteristic(ROC)curve evaluate the diagnostic efficiency of each indiactor.Results For the white blood cells(WBC),CRP and PCT positive rate,infection group were 91.4%,65.7% and 88.6% respectively,control group rate were77.8%,38.9% and 8.3% respectively.The rate of PCT diagnostic sensitivity and specificity were 82.9% and 94.4%respectively,the diagnosis had the best effect.Conclusion When there was the cough,asthma and lung rale in AMI patients,the PCT may contribute to identification of heart failure and pulmonary infection laboratory indicators early and rapidly,which may be helpful for reasonable application of antibiotics.
Objective To investigate the effects of serum procalcitonin in acute myocardial infarction(AMI)patients with heart failure and pulmonary infection of the differential diagnosis value.Methods The serum PCT of two groups of patients were measured with the fluorescent enzyme immunoassay technique.One of the two groups was 70 cases of AMI patients with heart failure and pulmonary infection(infection group),and the other group was 72 cases of AMI with heart failure(control group).Simultaneous determination of blood routine,NT-proBNP and C-reactive protein(CRP),echocardiography and pulmonary CT image or chest X-ray plain film.application of receiver operating characteristic(ROC)curve evaluate the diagnostic efficiency of each indiactor.Results For the white blood cells(WBC),CRP and PCT positive rate,infection group were 91.4%,65.7% and 88.6% respectively,control group rate were77.8%,38.9% and 8.3% respectively.The rate of PCT diagnostic sensitivity and specificity were 82.9% and 94.4%respectively,the diagnosis had the best effect.Conclusion When there was the cough,asthma and lung rale in AMI patients,the PCT may contribute to identification of heart failure and pulmonary infection laboratory indicators early and rapidly,which may be helpful for reasonable application of antibiotics.
引文
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[9]Firat Bektas,Secgin Soyuncu,Ilker Gunduz,et al.The value of procalcitonin,a novel inflammatory marker in the diagnosis of myocardial infarction and evaluation of acute coronary syndrome patients[J].The Journal of Emergency Medicine,2011,41(5):524.
[2]Singanayagam A,Elder DHJ,Chalmers JD,et al.Is community acquired pneumonia an independent risk factor for cardiovascular disease[J].The European Respiratory Journal,2012,39(1):187.
[3]吕颖,张永超.血清降钙素原水平在鉴别慢性痛风急性发作和细菌感染中的价值[J].安徽医药,2017,21(3):481.
[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380.
[5]程杨,汪爱民,陈晶.老年急性心肌梗死患者肺部感染的临床分析[J].中华医院感染学杂志,2014,24(23):5854.
[6]牛艳慧,高勇,王鑫,等.降钙素原水平与C反应蛋白对重症慢性阻塞性肺疾病患者的预测价值[J].临床肺科杂志,2015,20(8):1407.
[7]答嵘,王伟,雷金娥,等.降钙素原检测在血流感染患者中的应用评价[J].国际检验医学杂志,2015,36(18):2625.
[8]陈益平,汪洪姣,李伟,等.降钙素原在感染性腹泻诊断中的应用评价[J].中国实用儿科杂志,2004,19(3):176.
[9]Firat Bektas,Secgin Soyuncu,Ilker Gunduz,et al.The value of procalcitonin,a novel inflammatory marker in the diagnosis of myocardial infarction and evaluation of acute coronary syndrome patients[J].The Journal of Emergency Medicine,2011,41(5):524.