降钙素、D-二聚体、C 反应蛋白与重症社区获得性肺炎病情、预后判断的相关性研究

摘要

目的：研究降钙素（PCT）、D-二聚体、C 反应蛋白（CRP）水平与重症社区获得性肺炎病情、预后判断的相关性，为临床诊断、治疗方案制定及调整、预后评估提供依据。方法选择本院2012年1月至2013年9月接诊的100例社区获得性肺炎作为研究对象，其中非重症肺炎组50例，重症肺炎组50例，同期入组50例健康体检者作为对照组，按住院结局分为生存组和死亡组，入院后根据肺炎严重指数（PSI）评分系统进行评分，干预前后空腹抽血进行降钙素、D-二聚体、CRP 水平检测，比较不同组别患者 PCT、D-二聚体、CRP、PSI 水平差异，进行 PCT、D-二聚体、CRP 与PSI 相关分析。结果①非重症肺炎组、重症肺炎组、健康组之间的 PCT、D-二聚体、CRP 水平差异具有显著性，F ＝7．003、8．865、10．321，均 P ＜0．01，非重症肺炎组和重症肺炎组的 PCT、D-二聚体、CRP 水平明显高于健康组，t ＝3.839、9．745、11．656和7．552、13．707、16．721，P ＜0．05或 P ＜0．01，重症肺炎组的 PCT、D-二聚体、CRP、PSI 重症指数明显高于非重症肺炎组，t＝5．434、7．585、14．725、5．526，均 P ＜0．01。②死亡组 PCT、D-二聚体、CRP、PSI 重症指数具明显高于生存组，差异具有显著性，t＝8．834、9．372、12．011、3．783，P ＜0．05或 P ＜0．01。③PCT、CRP、D-二聚体水平与 PSI 评分均呈正相关，差异均有统计学意义（r＝0．645、0．713、0．462，P ＜0．05或 P ＜0．01）。结论降钙素、D-二聚体、C 反应蛋白检测对于重症社区获得性肺炎病情、预后判断具有重要临床意义，高水平的 PCT、D-二聚体、CRP 提示患者病情严重及预后不佳，应在临床推广使用。%Objective To study the correlation of Calcitonin,D-dimer and C-reactive protein for evalnating condition and prognosis in patients with severe commnnity acquired pnenmonia,provide the basis for diagnosis,development and adjustment of treatment plan,prognosis assessment.Methods 100 patiens with severe commnnity acquired pnenmonia from January 2012 to September 2013 in our hospital were included as research subjects,50 cases of the severe grou,50 cases of the non-severe group,50 healthy people were included as the control group,then all the patients with severe commnnity acquired pnenmonia were divided into survival group and death group according to hospitalization ending points,the PSI score were judged when entering hospital,Blood samples of all the patient were taken for detecting Cal-citonin,D-dimer and C-reactive protein which were compared between different group,the correlation of PSI and Calci-tonin,D- dimer and C-reactive protein were made.Results ① there were significant differences between the severe group,the non-severe group and the control group,F = 7.003,8.865,10.321,all P <0.01,the Calcitonin,D-dimer and C-reactive protein of the severe group and the non-severe group were significantly higher than the healthy group,t=3. 839、9.745、11.656 和 7.552、13.707、16.721,P <0.05 or P <0.01,the severe group were significantly higher than the non-severe group,t=5.434,7.585,14.725,5.526,all P <0.01.②the Calcitonin,D-dimer and C-reactive protein of the death group were significantly higher than the survival group,t=8.834,9.372,12.011,3.783,P <0.05 or P <0.01.③there were positive correlation between PCT,CRP,D-dimer and PSI score (r=0.645,0.713,0.462,P <0.05 or P <0.01).Conclusion the calcitonin,D-dimer,C-reactive protein detection has important clinical significance for patients with severe commnnity acquired pnenmonia,high level of PCT,D- dimer,CRP may prompt serious illness and poor prognosis,so These indicators should be used in clinical practice.