血清降钙素原水平在诊治老年心力衰竭合并肺炎患者中的临床意义

Clinical significance of procalcitonin level in elderly patients with heart failure and pneumonia

摘要:

目的 探讨血清降钙素原(PCT)水平对评价老年心力衰竭合并肺炎患者感染程度和预后的临床意义。方法 选择2016年2月至2018年2月上海市徐汇区中心医院心血管内科住院的心力衰竭患者206例,年龄>65岁,其中心力衰竭合并肺炎患者156例(心力衰竭合并肺炎组),单纯心力衰竭患者50例(心力衰竭组),另选取本科室同期住院的25例单纯肺炎患者作为阳性对照(肺炎组),检测并比较3组患者血清PCT水平。根据PCT水平将心力衰竭合并肺炎患者分为<0.5 μg/L,0.5≤PCT<2.0 μg/L,2.0≤PCT<5.0 μg/L,≥5.0 μg/L 4个亚组,分析各亚组的静脉抗生素使用率及使用时间、住院时间、多器官功能衰竭综合征(MODS)发生率、死亡率和细菌感染率差异。应用SPSS 19.0统计软件进行数据分析。根据数据类型,组间比较采用单因素方差分析、LSD-t检验或χ²检验。使用受试者工作特征(ROC)曲线分析PCT对心力衰竭合并肺炎的诊断效果。结果 心力衰竭合并肺炎组PCT水平为(2.210±1.014)μg/L,明显高于单纯心力衰竭组[(0.120±0.097)μg/L,t=13.583,P=0.000]和肺炎组[(1.031±0.425)μg/L,t=6.732,P=0.000],差异有统计学意义。PCT诊断老年心力衰竭合并肺炎的截断点为0.32 μg/L,灵敏度为87.8%,特异度为96.0%,阳性预测值为98.56%(137/139),阴性预测值为71.64%(48/67)。随PCT水平升高,4个亚组静脉抗生素使用率及使用时间、住院时间、MODS发生率、死亡率和细菌感染率均显著增加,差异有统计学意义(P<0.05)。结论 检测血清PCT水平对评价老年心力衰竭合并肺炎患者入院时感染严重度、指导抗生素治疗及评价患者预后有指导意义。

Abstract:

Objective To explore the clinical significance of the serum level of procalcitonin (PCT) in assessment of infection severity and prognosis in the elderly patients with heart failure (HF) and pneumonia. Methods A total of 206 HF elderly patients (over 65 years old), who admitted to our hospital from February 2016 to February 2018 were enrolled in this study. They were assigned into HF plus pneumonia group (HF+P, n=156) and merely heart failure group (HF, n=50). Another 25 simple pneumonia inpatients in our department during the same period were randomly recruited and served as positive control group (P). Serum PCT levels of all the subjects were detected and compared among the 3 groups. For the patients of the HF+P group, they were further divided into 4 groups according to the serum PCT level, that is, <0.5,0.5≤PCT<2.0,2.0≤PCT<5.0 and ≥5.0 μg/L subgroups. The utilization ratio and time of intravenous antibiotic, length of hospital stay, incidence rate of multiple organ dysfunction syndrome (MODS), mortality and bacterial infection rate of these patients were recorded and analyzed. SPSS statistics 19.0 was used for data analysis. According to the data type, one-way analysis of variance, LSD-t test or Chi-square test was used for comparison among groups. Receiver operating characteristic (ROC) curve analysis was preformed to analyze the diagnostic effect of PCT on HT+P. Results The serum PCT level was (2.210±1.014)μg/L in the HF+P group, significantly higher than that of the HF group [(0.120±0.097)μg/L, t=13.583, P=0.000] and the P group [(1.031±0.425)μg/L, t=6.732, P=0.000]. The cut-off value of PCT was 0.32 μg/L in the diagnosis of HF+P for the elderly, with a sensitivity of 87.8% and a specificity of 96.0%. The positive and negative predictive values were 98.56%(137/139) and 71.64%(48/67), respectively. With the increase of serum PCT level in the HF+P group, the [JP+2]utilization ratio and time of intravenous antibiotic, length of hospital stay, morbidity of MODS, mortality and bacterial infection rate were increased significantly (P<0.05). Conclusion The serum PCT level has clinical values in assessment of infection severity, guiding the treatment of antibiotics, and evaluating the prognosis in the elderly HF+P patients.