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目的探讨血清降钙素原(PCT)变化对重症社区获得性肺炎(SCAP)患者的疗效评价及临床意义。方法对2009年1月-2011年4月收治的60例SCAP患者,在入院后第0、1、2、3、4、5天留取静脉血2 mL,检测血清PCT、血常规和C-反应蛋白(CRP)。根据入院后第6天氧合指数(PaO2/FiO2)>250、停用血管活性药物,影像学肺部渗出出现吸收,以格拉斯哥昏迷评分>10分,尿量≥0.5 mL/(kg·d)为标准,将患者分为好转组和预后不良组,符合以上标准进入好转组(42例),反之进入预后不良组(18例)。用SAS 9.0软件对资料进行统计学分析,P值<0.05为有统计学意义。结果患者第0天的PCT和CRP呈正相关(r=0.38,P=0.00)。好转组的PCT最快出现明显下降,在治疗后第48小时下降29%。以PCT下降30%为判断预后的标准,第48小时的灵敏度和特异度分别为66.87%和85.50%,而第72、96和120小时的灵敏度分别为70.05%、79.88%、83.10%,特异度分别为100.00%、75.23%、100.00%。结论治疗后48 h的PCT下降幅度可为早期判断SCAP患者的治疗效果、更换临床药物提供依据,并可作为判断患者预后的一项临床指标。
Objective To investigate the clinical efficacy of serum procalcitonin (PCT) in patients with severe community acquired pneumonia (SCAP). Methods From January 2009 to April 2011, 60 SCAP patients were admitted to the hospital on the 0,1,2,3,4,5 days after venous blood was collected 2 mL, serum PCT, blood and C- Reactive protein (CRP). According to PaO2 / FiO2> 250 on the 6th day after admission, vasoactive drugs were withdrawn and the lungs were infiltrated with radiography. Glasgow coma score> 10 and urine output ≥0.5 mL / (kg • d ) As the standard, the patients were divided into improved group and poor prognosis group, in line with the above criteria into the improvement group (42 cases), and vice versa into the poor prognosis group (18 cases). SAS 9.0 software for statistical analysis of the data, P value <0.05 was statistically significant. Results There was a positive correlation between PCT and CRP on day 0 (r = 0.38, P = 0.00). In the remission group, the fastest decrease in PCT occurred at the earliest, with a 29% decrease 48 hours after treatment. The sensitivity and specificity of the 48th hour were 66.87% and 85.50%, respectively. The sensitivity at the 72th, 96th and 120th hour was 70.05%, 79.88% and 83.10% respectively, and the specificity Respectively 100.00%, 75.23%, 100.00%. Conclusions The reduction of PCT at 48 h after treatment may be the basis for judging the therapeutic effect of SCAP in early stage and the clinical drug replacement, and may be used as a clinical index to judge the prognosis of patients.