血清降钙素原联合C-反应蛋白动态监测在评价老年呼吸机相关性肺炎疗效中的价值
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摘要
目的探讨血清降钙素原(Procalcitonin,PCT)联合C-反应蛋白(C-reactive Protein,CRP)在老年人呼吸机相关性肺炎(Ventilator Associated Pneumonia,VAP)疗效评估中的临床价值。方法选取本院2017年1月-2017年12月收治的79例行机械通气(MV)老年患者,根据是否发生VAP分为VAP组(37例)和非VAP组(42例)。测定VAP组接受治疗后1 d、3 d和7 d血清PCT和CRP水平,根据治疗效果将VAP患者分为康复组(22例)和恶化组(15例),比较2组患者血清PCT和CRP的水平变化,绘制受试者工作(Receiver Operating Characteristic,ROC)曲线判断血清PCT和CRP预测老年VAP患者临床疗效的价值。结果在治疗3 d、7 d时,恶化组患者血清PCT、CRP均高于康复组,差异具有统计学意义(P<0.05),治疗后3 d血清PCT联合CRP检测判断老年VAP患者疗效的性能最佳。结论治疗后3 d血清PCT联合CRP可作为评估老年VAP患者疗效的最佳指标。
Objective To explore the value of serum procalcitonin(PCT) combined with C-reactive Protein(CRP) in evaluating the curative effect of ventilator associated pneumonia(VAP) in the elderly. Methods A total of 79 elderly patients with mechanical ventilation(MV) were selected in our hospital from January 2017 to December 2017. According to clinical manifestation, the patients were divided into VAP group(37 cases) and non VAP group(42 cases). Serum PCT and CRP levels in VAP group were measured at day 1, day 3 and day 7 after treatment. According to the therapeutic effect, VAP group patients were divided into the rehabilitation group(22 cases) and the worsening group(15 cases). The levels of serum PCT in the two groups were compared, and the receiver operating characteristic(ROC) curve was drawn to determine the value of serum PCT and CRP for predicting the clinical efficacy of the elderly patients with VAP. Results At day 3 and day 7 after treatment, the patients' serum PCT levels were higher than those in the rehabilitation group, and the difference was statistically significant(P<0.05). The results showed that the serum levels of PCT combined with CRP at day 3 after treatment were the best in judging the efficacy of VAP in elderly patients. Conclusion The serum PCT levels combined with CRP at day 3 after treatment are the key index to evaluate the curative effect of VAP in elderly patients.
Objective To explore the value of serum procalcitonin(PCT) combined with C-reactive Protein(CRP) in evaluating the curative effect of ventilator associated pneumonia(VAP) in the elderly. Methods A total of 79 elderly patients with mechanical ventilation(MV) were selected in our hospital from January 2017 to December 2017. According to clinical manifestation, the patients were divided into VAP group(37 cases) and non VAP group(42 cases). Serum PCT and CRP levels in VAP group were measured at day 1, day 3 and day 7 after treatment. According to the therapeutic effect, VAP group patients were divided into the rehabilitation group(22 cases) and the worsening group(15 cases). The levels of serum PCT in the two groups were compared, and the receiver operating characteristic(ROC) curve was drawn to determine the value of serum PCT and CRP for predicting the clinical efficacy of the elderly patients with VAP. Results At day 3 and day 7 after treatment, the patients' serum PCT levels were higher than those in the rehabilitation group, and the difference was statistically significant(P<0.05). The results showed that the serum levels of PCT combined with CRP at day 3 after treatment were the best in judging the efficacy of VAP in elderly patients. Conclusion The serum PCT levels combined with CRP at day 3 after treatment are the key index to evaluate the curative effect of VAP in elderly patients.
引文
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[9] 张帅,韩芳,林蕊艳,等.CRP及PSI评分在社区获得性肺炎中的应用价值[J].临床肺科杂志,2011,16(6):821-822.
[10] 朱建芸,黄建华,李齐光,等.血清降钙素原、C反应蛋白在老年肺部感染患者中的诊断价值[J].中国卫生检验杂志,2015,25(17):2905-2907.
[11] 樊海燕.降钙素原在感染性疾病中的应用价值[J].现代中西医结合杂志,2015,24(1):89-91.
[12] 宇世飞,李芳秋.降钙素原的临床应用进展[J].医学研究生学报,2016,29(2):206-209.
[13] 朱丽康,钟宏文,曾金石,等.降钙素原联合C反应蛋白动态观察在老年呼吸机相关肺炎疗效判断中的作用[J].临床检验杂志:电子版,2017,6(2):355-356.
[14] 黄晓文,陆建红,陈国军,等.血清降钙素原与C 反应蛋白测定在感染性疾病中的临床意义[J].中国卫生检验杂志,2015,25(13):2141-2142.
[15] Windgassen EB,Funtowicz L,Lunsford TN,et al.C-reactive protein and high-sensitivity C-reactive protein:an update for clinicians[J].Postgrad Med,2011,123(1):114-119.
[16] 陈凤佳,匡煜坤,陈海红,等.前降钙素原、C-反应蛋白和临床肺部感染评分对呼吸机相关性肺炎诊断的意义[J].中山大学学报:医学科学版,2014,35(3):418-423.
[2] 瓦永禄,孟建斌,华岚春.降钙素原与感染细胞监测在呼吸机相关性肺炎的早期诊断价值[J].中华医院感染学杂志,2015,25(15):3364-3368.
[3] 何力敏,张韶冈,陈于荦,等.降钙素原在老年人呼吸机相关性肺炎中的应用[J].现代预防医学,2011,38(19):4038-4039.
[4] 韦艳,李晓阳,丁丽丽,等.重症监护病房呼吸机相关性肺炎的危险因素分析[J].中国感染与化疗杂志,2014,14(1):7-10.
[5] 蔡晓平,钱俊峰,曹卓,等.动态监测血清降钙素原在呼吸机相关性肺炎诊治中的指导意义[J].放射免疫学杂志,2013,26(2):247-249.
[6] 中华医学会重症医学分会.呼吸机相关性肺炎预防、诊断和治疗指南(2013)[J].中华内科学杂志,2013,52(6):1.
[7] 魏萍,刘小香,朱捍君,等.无菌吸痰管在机械通气患者下呼吸道感染病原学诊断中的应用及评价[J].中国卫生检验杂志,2017,27(3):358-360.
[8] 李淑媛,盖鑫,张建,等.ICU机械通气患者呼吸机相关性肺炎危险因素与干预措施[J].中华医院感染学杂志,2016,26(1):76-78.
[9] 张帅,韩芳,林蕊艳,等.CRP及PSI评分在社区获得性肺炎中的应用价值[J].临床肺科杂志,2011,16(6):821-822.
[10] 朱建芸,黄建华,李齐光,等.血清降钙素原、C反应蛋白在老年肺部感染患者中的诊断价值[J].中国卫生检验杂志,2015,25(17):2905-2907.
[11] 樊海燕.降钙素原在感染性疾病中的应用价值[J].现代中西医结合杂志,2015,24(1):89-91.
[12] 宇世飞,李芳秋.降钙素原的临床应用进展[J].医学研究生学报,2016,29(2):206-209.
[13] 朱丽康,钟宏文,曾金石,等.降钙素原联合C反应蛋白动态观察在老年呼吸机相关肺炎疗效判断中的作用[J].临床检验杂志:电子版,2017,6(2):355-356.
[14] 黄晓文,陆建红,陈国军,等.血清降钙素原与C 反应蛋白测定在感染性疾病中的临床意义[J].中国卫生检验杂志,2015,25(13):2141-2142.
[15] Windgassen EB,Funtowicz L,Lunsford TN,et al.C-reactive protein and high-sensitivity C-reactive protein:an update for clinicians[J].Postgrad Med,2011,123(1):114-119.
[16] 陈凤佳,匡煜坤,陈海红,等.前降钙素原、C-反应蛋白和临床肺部感染评分对呼吸机相关性肺炎诊断的意义[J].中山大学学报:医学科学版,2014,35(3):418-423.