降钙素原对肺挫伤继发肺部感染的早期诊断价值*

苏娴1王月宾1朱姝颖2陈锋1王晓霞1包勇1

(1.成都市第三人民医院呼吸科, 四川 成都 610031；2.四川省第二人民医院麻醉科， 四川 成都 610041)

【摘要】目的评价降钙素原(PCT)在肺挫伤继发肺部感染中的早期诊断价值。方法将救治的创伤后肺挫伤患者52例分为感染组20例和非感染组(32例)，同时选取健康对照组22例。分别在受伤2小时内及入院第1、3、5天对患者进行白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)测定， 并对各组间进行分析比较。结果肺挫伤感染组与非感染组的临床症状、体征无统计学差异。不同时间，白细胞计数在各组间均无明显差异(P>0.05)。CRP在受伤第1天、第3天持续升高，在第5天开始下降，但其在肺挫伤非感染组、感染组与健康组间均有明显差异(P<0.05)。PCT在肺挫伤感染组持续升高，与健康组有明显统计学差异(P<0.05)；而非感染组与健康组无明显差异(P>0.05)。结论PCT在肺挫伤合并感染患者中可见明显持续增高，可作为早期诊断肺挫伤继发感染的临床参考依据并及时抗感染治疗，能明显改善患者预后。

【关键词】降钙素原； 肺挫伤； 肺部感染； 糖皮质激素； C反应蛋白

【中图分类号】R 563

【文献标志码】A

doi：10.3969/j.issn.1672-3511.2015.10.016

Abstract【】ObjectiveTo assess the early diagnosis value of PCT for pneumonia in trauma patients with pulmonary contusion. Methods52 patients with pulmonary contusion were studied including 20 cases with pneumonia and 32 cases without pneumonia and controlled with 22 healthy (control group). Leucocyte count, C reactive protein, and procalcitonin were measured within two hours and on the first, third and fifth day after the injury.ResultsThere was no statistical differences in the clinical symptoms and signs in Patients with pneumonia and without pneumona. The level of leucocyte count had no obvious difference in three groups (P>0.05). CRP was increased in first and third day, and began to decline in fifth day. CRP in pulmonary contusion patients, both with or without pneumonia, was significantly higher than that in healthy groups(P<0.05). But no difference between pneumonia patients and non-infective patients. Patients with pneumonia had significantly higher PCT levels than non-infective patients and healthy controls (P<0.05).Conclusion Procalcitonin represents is a good biological diagnostic marker for pneumonia in trauma patients with pulmonary contusion, and it is superior to C-reactive protein.

基金项目：四川省卫生厅科研课题(110022)

通讯作者：朱姝颖，E-mail：tomatojuicesu@163.com

收稿日期：( 2015-04-01； 编辑： 陈舟贵)

The early diagnosis value of PCT for pneumonia in trauma patients with pulmonary contusionSU Xian，WANG Yuebin，ZHU Suyin，etal

(1.DepartmentofRespiratory,TheThirdPeople’sHospitalofChengdu,Chengdu610031,China；

2.TheSecondPeople’sHospitalofSichuan,Chengdu610041,China)

【Key words】Procalcitionin； Pulmonary contusion； Pneumonia； C-reactive protein； Glucocorticoid

肺挫伤是胸部钝性伤常见的肺实质损伤，约占外伤发病的5%，死亡率14%～40%[1]，严重肺挫伤易恶化急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)。而继发肺部感染时，更加重肺损伤，ARDS发生率升高，死亡率增加。因此早期诊断继发感染，早期干预，对改善预后尤为重要[2]。降钙素原是一种高敏感性、特异性的反应感染导致炎症损伤程度的指标，它在细菌或真菌感染合并严重全身系统反应时显著升高，且能用于判断治疗的有效性、疾病的严重程度和预后。本文……