降钙素原、C反应蛋白、白细胞计数与社区获得性肺炎严重程度及预后的关系

发布时间：2018-02-26 19:02

本文关键词： 社区获得性肺炎生物学指标严重程度 ICU治疗预后　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究生物学指标降钙素原(Procalcitonin,PCT),白细胞计数(White Blood Count,WBC),C反应蛋白(C Reactive Protein,CRP)与社区获得性肺炎社区获得性肺炎(community acquired pneumonia,CAP)严重程度之间的关系,以及上述三种生物学指标在判断CAP患者是否需要进入ICU治疗及预后的诊断价值。方法:收集2015年9月至2016年9月皖南医学院弋矶山医院收治的CAP患者70例其中包括呼吸内科收治的CAP患者40例,重症医学科(ICU)收治的CAP换30例所有患者诊断符合《中国成人社区获得性肺炎诊断及治疗指南2016版》中指定的诊断标准。同时,应用SPSS19.0统计软件分析该上述生物学指标与患者临床资料之间的关系。结果:入院时患者情况根据CURB-65评分分为低中高危三组。其中高危组患者的住院天数(38±30天)明显高于低危组(13±10天)中危组(14±8天),高危组PCT(6.5±1.7),白细胞计数(12.8±5.2)数高于中危组白细胞计数(11.5±2.9)PCT(5.5±0.2)及低危组白细胞计数(9.9±2.1)PCT(5.5±0.2),经统计学检验有意义(P0.05)上述三组患者中PCT水平存在明显差异,高危组患者PCT水平高于中危组及低危组。根据Spearman相关性分析其中患者PCT水平与患者CRUB65评分严重程度呈正相关(Spearman=0.788)且具有统计学意义P0.05ICU治疗组患者住院天数42±32天明显高于非ICU治疗组。ICU治疗组患者白细胞计数(12.5±5.2)及PCT水平(6.8±1.7)高于非ICU治疗组患者白细胞计数(10.9±3.2)及PCT水平(5.0±2.0),上述两组之间生物学标志物水平差异具有统计学意义(P0.05)。PCT,WBC,CRP对于判断患者是否需要进入ICU治疗受试者工作特征曲线下面积(ROC-AUC)分别为0.958,0573,0.592经比较发现PCT受试者工作特征曲线下面积高于CRP和WBC,表明PCT在判断患者是否需要进入ICU治疗具有更高的诊断价值。死亡组患者年龄76±19,PCT7.3±2.1,白细胞计数14.0±6.6(WBC)水平高于存活组年龄66±14岁,PCT5.4±1.9mg/L,白细胞计数11.2±3.5ug/ml并具有统计学意义(P0.05),而存活组和死亡组CRP的水平差异则无明显统计学意义。PCT,WBC,CRP对于判断患者转归(是否死亡)治疗受试者工作特征曲线下面积(ROC-AUC)分别为0.861,0.584,0.693经比较发现PCT受试者工作特征曲线下面积高于(ROC-AUC)CRP和WBC,表明PCT在判断患者预后诊断价值更高。结论:PCT,CRP,WBC在判断CAP患者严重程度上具有诊断学意义,其中PCT与CAP患者严重程度相关性最高具有明显诊断价值。在预测患者是否进入ICU治疗以及患者预后PCT较CRP,WBC诊断价值更高。
[Abstract]:Objective: to study the relationship between the biological index Procalcitonin Blood, white blood cell count (WBC) and the severity of community acquired pneumonia (acquired) community pneumoniae pneumoniae (acquired). And the diagnostic value of the above three biological indexes in judging whether CAP patients need to enter ICU treatment and prognosis. Methods: from September 2015 to September 2016, 70 cases of CAP patients admitted to Yiji Mountain Hospital of Southern Anhui Medical College were collected. Including 40 patients with CAP treated in Department of Respiratory Medicine, The diagnosis of 30 patients with CAP met the criteria specified in the guidelines for the diagnosis and treatment of Adult Community acquired pneumonia in China (2016). At the same time, SPSS19.0 statistical software was used to analyze the relationship between the above biological indexes and the clinical data. Results: according to the CURB-65 score, the patients were divided into three groups of low, middle and high risk. The hospitalization days of the patients in the high risk group were 38 卤30 days. It was significantly higher than that in the low risk group (14 卤8 days), the high risk group (PCT(6.5 卤1.7) and the white blood cell count (12.8 卤5.2) were significantly higher than those in the middle risk group (11.5 卤2.9) and the low-risk group (5.5 卤2.1) and the white blood cell count (5.5 卤0.2) was significantly higher than that in the low risk group. There was significant difference in PCT level among the three groups. The level of PCT in high risk group was higher than that in middle risk group and low risk group. According to Spearman correlation analysis, there was a positive correlation between PCT level and CRUB65 score (0.788). The white blood cell count (WBC) and PCT level in ICU group were significantly higher than those in non ICU group (10. 9 卤3. 2) and PCT (5. 0 卤2. 0), respectively. There was significant difference between these two groups in the level of biological markers (P 0. 05???)? The area under the operating characteristic curve of patients who need to enter the ICU treatment is 0.958 / 0573U / AUC = 0.958 / 0573U / 0.592, respectively. The comparison shows that the area under the operating characteristic curve of PCT subjects is higher than that of CRP and WBC, indicating that PCT is used to judge whether the patients need to enter ICU therapy or not. The age of the patients in the death group was 76 卤19 PCT 7.3 卤2.1, and the white blood cell count was 14.0 卤6.6 渭 g / L, which was higher than that in the survival group, which was 5.4 卤1.9 mg / L, and the white blood cell count was 11.2 卤3.5 ugr / ml and had statistical significance (P 0.05). However, there was no significant difference between the survival group and the death group in CRP level. The area under the operating characteristic curve of PCT patients is 0.861 ~ 0.584 ~ 0.693 respectively. It is found that the area under the operating characteristic curve of PCT subjects is higher than that of ROC-AUC and WBC, indicating that PCT is used to judge the patients. Conclusion the diagnostic value of CAP is significant in judging the severity of CAP. The highest correlation between PCT and the severity of CAP is of great diagnostic value, and the diagnostic value of PCT in predicting the entry of ICU and the prognosis of PCT is higher than that of CAP.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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