不同病原菌所致重症肺炎患者白细胞计数、降钙素原、C-反应蛋白及白细胞介素-6水平
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摘要
目的探讨白细胞(WBC)计数、降钙素原(PCT)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)水平在不同病原菌所致重症肺炎患者中的差异,为重症肺炎的诊治提供理论依据。方法选取2014年10月至2017年3月在惠州市第一人民医院接受治疗且满足纳入标准的重症肺炎患者78例,根据病原菌种类将患者随机分为单一感染组:真菌组(F)、革兰阳性菌组(G+)、革兰阴性菌组(G-)和复合感染组:真菌+革兰阳性菌组(F+G+)、真菌+革兰阴性菌组(F+G-),共5组。比较各组患者PCT、CRP、WBC计数和IL-6水平。结果各组患者基础疾病、收缩压、体温、心率、红细胞沉降率差异均无统计学意义(P均>0.05);各组患者血清PCT水平差异有统计学意义(F=9.781、P=0.007);各组患者血清WBC水平差异均有统计学意义(F=8.373、P=0.005)。各组患者CRP和IL-6水平变化范围小,差异均无统计学意义(F=1.203、P=0.115,F=4.572、P=0.248)。结论低水平PCT和高水平CRP提示重症肺炎患者为真菌感染,降钙素原显著上升表明重症肺炎患者为革兰阴性杆菌感染或为复合感染。
Objective To investigate the count of white blood cell(WBC) levels,procalcitonin(PCT),C-reactive protein(CRP) and interleukin-6(IL-6) in patients with severe pneumonia caused by different pathogens,and to provide a theoretical basis for the diagnosis and treatment of pneumonia.Methods From October 2014 to March 2017,a total of 78 patients with severe pneumonia treated in the First People's Hospital of Huizhou City who met the inclusion criteria were randomly divided into 5 groups according to the type of pathogenic bacteria,which were single infection group:fungi group(F),Gram-positive bacteria group(G+),Gram-negative bacteria group(G-) and coinfection group:fungi + Gram-positive bacteria group(F + G+),fungi + Gram-negative bacteria group(F + G-).The levels of PCT,CRP,WBC count and IL-6 were detected and compared,respectively.Results There was no significant difference among basic diseases,systolic blood pressure,body temperature,heart rate and erythrocyte sedimentation rate among the five groups(all P>0.05).There were significant differences in serum PCT and WBC levels among the five groups(F=9.781,P=0.007;F=8.373,P=0.005).Levels of CRP and IL-6 in each group were with small range of changes,but with no significant difference(F=1.203,P=0.115;F=4.572,P=0.248).Conclusions The low level of PCT and high level of CRP indicate that patients with severe pneumonia are infected by fungal,while the increase of procalcitonin indicates that patients with severe pneumonia are infected by Gramnegative bacilli or with compound infection.
Objective To investigate the count of white blood cell(WBC) levels,procalcitonin(PCT),C-reactive protein(CRP) and interleukin-6(IL-6) in patients with severe pneumonia caused by different pathogens,and to provide a theoretical basis for the diagnosis and treatment of pneumonia.Methods From October 2014 to March 2017,a total of 78 patients with severe pneumonia treated in the First People's Hospital of Huizhou City who met the inclusion criteria were randomly divided into 5 groups according to the type of pathogenic bacteria,which were single infection group:fungi group(F),Gram-positive bacteria group(G+),Gram-negative bacteria group(G-) and coinfection group:fungi + Gram-positive bacteria group(F + G+),fungi + Gram-negative bacteria group(F + G-).The levels of PCT,CRP,WBC count and IL-6 were detected and compared,respectively.Results There was no significant difference among basic diseases,systolic blood pressure,body temperature,heart rate and erythrocyte sedimentation rate among the five groups(all P>0.05).There were significant differences in serum PCT and WBC levels among the five groups(F=9.781,P=0.007;F=8.373,P=0.005).Levels of CRP and IL-6 in each group were with small range of changes,but with no significant difference(F=1.203,P=0.115;F=4.572,P=0.248).Conclusions The low level of PCT and high level of CRP indicate that patients with severe pneumonia are infected by fungal,while the increase of procalcitonin indicates that patients with severe pneumonia are infected by Gramnegative bacilli or with compound infection.
引文
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[18]叶继锋,陈瑞杰,侯齐书.儿童重症肺炎患者病原菌分布特点及药敏结果分析[J].中国消毒学杂志,2016,33(8):752-755.
[19]王芳,高凤娟,蒋敏,等.重症肺炎病原菌分布及耐药性分析[J].临床军医杂志,2017,45(11):1196-1198.
[20]王爱皎.老年重症肺炎患者的临床特点,菌耐药性及死亡相关因素[J].中国医刊,2017,52(3):84-87.
[21]郭霞,喻昌利,安庆丽,等.老年重症肺炎患者病原学分布及预后危险因素分析?[J].广东医学,2016,37(6):873-875.
[22]陈绵军,陈军,谭德敏,等.老年重症肺炎患者病原学分布及死亡危险因素分析[J].中国热带医学,2017,17(9):915-920.
[23]丁薇,赵云峰.早期适量应用糖皮质激素对重症肺炎患者临床疗效的观察[J].临床肺科杂志,2016,21(6):971-974.
[24]曾文新,黄园,邓郁,等.真菌(1,3)-β-D葡聚糖检测在重症肺炎患者中真菌检测的临床价值[J].中华急诊医学杂志,2016,25(5):659-662.
[25]刘东华,郝团云.替加环素治疗泛耐药鲍曼不动杆菌所致重症肺炎的疗效分析[J].实用心脑肺血管病杂志,2016,24(12):101-103.
[2]Ali KB,Farzin G,Daryoush M.Precalcitonin and C-reactive protein as markers in response to antibiotic treatment in ventilator-associated pneumonia in intensive care unit-hospitalized patients[J].Advanc Biomed Res,2015,4(1):240-245.
[3]张凯,张召,成云云.降钙素原、C-反应蛋白、前清蛋白及白细胞计数在小儿重症肺炎诊断中的应用评价[J].中国实验诊断学,2016,20(7):1128-1130.
[4]宋国强,卢火佺,陈墩顺,等.亚胺培南/西司他丁对重症肺炎患者血清CRP及降钙素原水平影响研究[J].中国生化药物杂志,2016,5(2):54-56.
[5]占林兵,谢波,华锋,等.血清C-反应蛋白,降钙素原及乳酸在重症肺炎中的变化及临床意义[J].中华全科医学,2015,13(3):367-368.
[6]Bordon JM,Fernandez-Botran R,Wiemken TL,et al.Bacteremic pneumococcal pneumonia:clinical outcomes and preliminary results of inflammatory response[J].Infection,2015,43(6):729-738.
[7]Liu D,Su LX,Guan W,et al.Prognostic value of procalcitonin in pneumonia:A systematic review and meta-analysis[J].Respirology,2016,21(2):280-288.
[8]Jiang L,Feng B,Gao D,et al.Plasma concentrations of copeptin,C-reactive protein and procalcitonin are positively correlated with APACHEⅡscores in patients with sepsis[J].J Int Med Res,2015,43(2):1881-1895.
[9]Jovanovic B,Milan Z,Markovic-Denic L,et al.Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre[J].J Infect Dis,2015,38(4):46-51.
[10]朱婉凌,李增艳,王敏.老年重症肺炎患者降钙素原,凝血及纤溶检测的临床意义[J].中国民康医学,2017,29(7):44-45.
[11]李琼,张晚生,史加强,等.动态监测重症肺炎患者血清降钙素原的临床意义[J].中国实用医刊,2016,43(10):115-116.
[12]Bello S,Fandos S,Lasierra AB,et al.Red blood cell distribution width[RDW]and long-term mortality after community-acquired pneumonia.A comparison with proadrenomedullin[J].Resp Med,2015,109(9):1193-1196.
[13]Nickler M,Schaffner D,Christ-Crain M,et al.Prospective evaluation of biomarkers for prediction of quality of life in community-acquired pneumonia[J].Clin Chem Lab Med,2016,54(11):1831-1846.
[14]Ito R,Shindo Y,Kobayashi D,et al.Molecular epidemiological characteristics of Klebsiella pneumoniae associated with bacteremia among patients with pneumonia[J].J Clin Microbiol,2015,53(3):879-886.
[15]周甘平,林春燕,黄华田.老年重症肺炎患者降钙素原的动态变化及其抗感染治疗的价值分析[J].抗感染药学,2015,3(2):200-203.
[16]杨梅雨,张新萍.心肌肌钙蛋白Ⅰ,白介素-6及降钙素原在小儿重症肺炎诊断的临床意义[J].中国医师杂志,2015,17(11):1733-1734.
[17]陈海襄,朱维娜,隆红艳.重症肺炎患者病原菌与证型关系的回顾性研究[J].中国中医急症,2015,24(11):1959-1960.
[18]叶继锋,陈瑞杰,侯齐书.儿童重症肺炎患者病原菌分布特点及药敏结果分析[J].中国消毒学杂志,2016,33(8):752-755.
[19]王芳,高凤娟,蒋敏,等.重症肺炎病原菌分布及耐药性分析[J].临床军医杂志,2017,45(11):1196-1198.
[20]王爱皎.老年重症肺炎患者的临床特点,菌耐药性及死亡相关因素[J].中国医刊,2017,52(3):84-87.
[21]郭霞,喻昌利,安庆丽,等.老年重症肺炎患者病原学分布及预后危险因素分析?[J].广东医学,2016,37(6):873-875.
[22]陈绵军,陈军,谭德敏,等.老年重症肺炎患者病原学分布及死亡危险因素分析[J].中国热带医学,2017,17(9):915-920.
[23]丁薇,赵云峰.早期适量应用糖皮质激素对重症肺炎患者临床疗效的观察[J].临床肺科杂志,2016,21(6):971-974.
[24]曾文新,黄园,邓郁,等.真菌(1,3)-β-D葡聚糖检测在重症肺炎患者中真菌检测的临床价值[J].中华急诊医学杂志,2016,25(5):659-662.
[25]刘东华,郝团云.替加环素治疗泛耐药鲍曼不动杆菌所致重症肺炎的疗效分析[J].实用心脑肺血管病杂志,2016,24(12):101-103.