降钙素原测定在心力衰竭合并肺部感染中的诊断价值

发布时间：2018-04-15 02:00

本文选题：心力衰竭 + 肺部感染　；参考：《承德医学院》2017年硕士论文

【摘要】：目的:探讨降钙素原(procalcitonin,PCT)水平测定在心力衰竭合并肺部感染中的临床意义及诊断界值。方法:纳入标准:回顾性分析2013-10-2016-03共401例住院患者,其中心力衰竭合并肺部感染患者101例、单纯心力衰竭患者100例、单纯肺部感染患者100例、正常对照组(无心力衰竭无感染)的患者100例。心衰病因包括冠心病、高血压性心脏病、扩张型心肌病及心脏瓣膜病。搜集分析各例患者入院时血清PCT水平。排除标准:(1)心源性休克患者;(2)肾功能异常者;(3)急性心肌梗死、严重外伤、重大手术、严重烧伤、持续严重器官灌注异常、小细胞肺癌、甲状腺髓质C细胞癌者。(4)自身免疫性疾病、代谢性疾病。(5)中毒。诊断标准:心力衰竭诊断标准根据2012年ESC急性和慢性心力衰竭诊断和治疗指南;心功能分级参照美国纽约心脏病协会(New York heart association,NYHA)心力衰竭分级标准。肺部感染诊断标准根据2013年中华医学会呼吸病学分会发布社区获得性肺炎诊断和治疗指南。综上所述分别诊断单纯心力衰竭及单纯肺部感染,满足上述两项诊断标准则诊断心力衰竭合并肺部感染。统计分析:采用SPSS 19.0统计软件包整理录入资料,定量资料符合正态分布用?x±s表示,多组方差分析法检验。定性资料选择χ2检验。资料不服从正态分布时多组间差异比较采用秩和检验,两两比较时采用LSD-t法,P0.05为差异具有统计学意义。计算心力衰竭合并肺部感染组患者PCT定量值的单侧95%参考值范围。通过ROC曲线,获得PCT诊断心力衰竭合并肺部感染最佳诊断界值。分别以单侧95%参考值、最佳诊断界值、0.5ng/ml、2ng/ml为界值计算心力衰竭患者合并肺部感染时诊断肺部感染的灵敏度(sensitivity,Se)、特异度(specificity,Sp)、阳性预测值(positive predictive value,PPV)和阴性预测值(negative predictive value,NPV)。结果:心力衰竭合并肺部感染组PCT值高于单纯心力衰竭组PCT值(P0.05)及正常对照组PCT值(P0.05);心力衰竭合并肺部感染组PCT值略高于单纯肺部感染组,但无统计学差别(P0.05);单纯心力衰竭组PCT值低于单纯肺部感染组(P0.05)但高于正常对照组(P0.05);单纯肺部感染组PCT值高于正常对照组(P0.05)。心力衰竭合并肺部感染组患者血清PCT单侧95%参考值(P5):0.03ng/ml。计算第五百分位数(P5)PCT值为0.03ng/ml,说明有95%患者PCT值大于0.03ng/ml。据ROC曲线表明:当PCT值为0.14ng/ml时曲线下面积最大为71.9%,Youden指数为0.375。所以,PCT诊断合并心力衰竭的肺部感染的最佳诊断界值为0.14ng/ml。以0.03ng/ml、0.14ng/ml、0.5ng/ml、2ng/ml为界值计算心力衰竭患者合并肺部感染时PCT诊断肺部感染的灵敏度(Se)、特异度(Sp)、阳性预测值(PPV)、阴性预测值(NPV)分别如下:0.03ng/ml时灵敏度、特异度、阳性预测值、阴性预测值分别是92.1%、21%、54.1%、72.4%;0.14ng/ml时灵敏度、特异度、阳性预测值、阴性预测值分别是48.5%、86%、77.8%、62.3%;0.5ng/ml时灵敏度、特异度、阳性预测值、阴性预测值分别是21.8%、95%、81.5%、54.6%;2ng/ml时灵敏度、特异度、阳性预测值、阴性预测值分别是1%、99%、90.9%、52.1%。结论:1.血清PCT的测定诊断感染性疾病有非常高的灵敏度及特异度,其对于心力衰竭合并肺部感染的诊断同样存在很高的诊断价值,可对临床肺部感染的诊断提供帮助,有助于患者早期应用抗生素早期控制病情。2.以第五百分位数(P5)为参考,血清PCT浓度小于0.03ng/ml的心力衰竭患者可基本除外肺部感染。3.根据ROC曲线得出:心力衰竭合并肺部感染时PCT值诊断肺部感染的最佳诊断界值为0.14ng/ml,为临床提供参考。4.单纯心力衰竭患者血清PCT浓度同样会升高,临床工作中应注意鉴别。
[Abstract]:Objective : To investigate the clinical significance and diagnostic value of procalpramide ( PCT ) in patients with heart failure complicated with pulmonary infection . Methods : 100 patients with heart failure complicated with pulmonary infection , 100 patients with heart failure complicated with pulmonary infection , 100 patients with simple pulmonary infection and 100 normal controls ( without heart failure ) . The diagnostic criteria for diagnosis and treatment of cardiac failure in patients with heart failure combined with pulmonary infection were determined by using SPSS 10.0 statistical software package . Results : PCT value of patients with heart failure combined with pulmonary infection was higher than that in normal control group ( P0.05 ) . The PCT value of patients with heart failure combined with pulmonary infection was higher than that in normal control group ( P0.05 ) . The PCT value of PCT in patients with heart failure was higher than that of normal control group ( P0.05 ) . The sensitivity , specificity , positive predictive value and negative predictive value were respectively 48.8 % , 95 % , 81.5 % and 54.6 % when the PCT value was 0 . 03ng / ml . Conclusion : 1 . The diagnostic value of PCT in patients with heart failure complicated with pulmonary infection is high sensitivity and specificity . Conclusion : 1 . The diagnostic value of PCT in diagnosis of cardiac failure complicated with pulmonary infection has very high sensitivity and specificity .

【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6;R563.1

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