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回顾性分析PCT和高灵敏度C-反应蛋白在确诊老人肺部感染中的价值 预览

Retrospective analysis of the value of PCT and high sensitivity C-reactive protein in the diagnosis of pulmonary infection in the elderly
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摘要 目的评估降钙素原(PCT)和高灵敏度C-反应蛋白(hs-CRP)在确诊呼吸道症状的65岁以上多发性病人队列中诊断肺部感染的作用。方法通过回顾性队列研究设计,对2016年8月至2017年8月因呼吸系统症状在宜宾市第二人民医院接受治疗的所有65岁以上多发病患者进行评估,收集每名患者的肺部感染诊断、合并症评分(CIRS)、生活方式、住院天数、入院时血清hs-CRP和PCT。使用Mann-Whitney的U检验和多变量Cox逻辑回归分析比较患有和未患肺部感染受试者的相关参数。使用接受者操作特征(ROC)曲线来验证每个生物标志物与肺部感染诊断的关联。结果与无肺部感染患者相比,肺部感染入院时血清hs-CRP、PCT水平和病房住院时间均显著提高(P<0.05)。各指标检测肺部感染的最佳统计截止值为:PCT浓度为0.26ng/mL(灵敏度为69.1%,特异度为85.3%),hs-CRP为61mg/L(灵敏度为84.0%,特异度为75.5%)和WBC为11470mm3(灵敏度为84.9%,特异度为47.4%);联合检测PCT≥0.26ng/mL与Hs-CRP≥61mg/L可以提高灵敏度(92.0%)及特异度(90.3%)。多变量Cox回归模型分析结果显示,入院时血清hs-CRP>61mg/L肺部感染风险增加3.59倍(OR3.59,95%CI:2.35-5.48,P<0.001)和PCT>0.26ng/mL肺部感染风险增加2.81倍(OR2.81,95%CI:2.14-4.87,P<0.001)。结论hs-CRP和PCT是预测多发病老年患者肺部感染有价值的指标,二者联合检测有助于提高诊断价值。 Objective To evaluate the role of procalcitonin (PCT) and high sensitivity C-reactive protein (hs-CRP) in the diagno. sis of pulmonary infection in a cohort of patients over 65 years of age with multiple respiratory symptoms. Methods With a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to our hospital from August 2016 to August 2017 were evaluated. Pulmonary infection diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and PCT at admission were collected for each patient. Data were analyzed with Mann-Whitney's U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker's association with pneumonia diagnosis. Results Compared with patients without pulmonary infection, the levels of serum hs-CRP, PCT and hospital stay in patients with pulmonary infection were significantly increased (P < 0.05). The best statistical cut-off values for detection of pulmonary infection were as follows: PCT concentration was 0.26 ng/mL (sensitivity 69.1%, specificity was 85.3%), hs-CRP was 61 mg/L (sensitivity 84%, specificity 75.5%) and WBC was 11 470 mm3 (sensitivity 84.9%, specificity was 47.4%);Combined detection of PCT > 0.26 ng/mL and Hs-CRP > 61 mg/L could be used to improve sensitivity (92%) and specificity (90.3%). The multivariate Cox regression model analysis showed that the risk of pulmonary infection of hs-CRP >61 mg/L increased by 3.59 times at admission (OR 3.59, 95%CI: 2.35-5.48, P <0.001) and PCT>0.26 ng/mL increased by 2.81 times (OR 2.81, 95%CI: 2.14- 4.87, P <0.001). Conclusion Both PCT and hs-CRP are valuable markers in predicting pulmonary infection in elderly patients with multiple diseases, and the combined detection of them may help to improve the diagnostic value.
作者 张艳琳 熊昊 Zhang Yanlin;Xiong Hao(The Second People's Hospital of Yibin, Yibin 644000, Sichuan, China)
出处 《医院与医学》 2019年第1期68-73,共6页 Hospital and Medicine
关键词 肺部感染 多发病 降钙素原 超敏C-反应蛋白 灵敏度 特异度 Pulmonary infection Multimorbid elderly Procalcitonin High sensitivity C- reactive protein Sensitivity Specificity
作者简介 通讯作者:张艳琳,主治医师,研究方向:呼吸与危重症.
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