姜轶飞++杨猛++莫伟强

[摘要] 目的 探讨血清降钙素原（PCT）及超敏C反应蛋白（hs-CRP）水平对老年社区获得性肺炎（CAP）患者严重程度评估的临床应用价值。 方法 根据CURB-65评分将浙江省嘉兴市第二医院2013年1月～2016年7月收治的58例老年CAP患者分为低危组23例，中危组18例，高危组17例。采用Kruscal-Wallis单因素ANOVA多重比较检验分析各组间PCT和hs-CRP水平的差异，采用Spearman相关分析进行CURB-65评分与PCT和hs-CRP水平的相关性分析，采用ROC曲线评估PCT和hs-CRP诊断高危CAP的效能。结果 高、中、低危组的PCT和hs-CRP水平依次降低（P < 0.01），CURB评分与PCT（r = 0.765，P < 0.01）和hs-CRP水平正相關（r = 0.745，P < 0.01），PCT和hs-CRP的曲线下面积分别为0.87和0.72。 结论 检测血清PCT和hs-CRP水平联合CURB-65评分对老年CAP患者严重程度的评估有重要的临床应用价值。

[关键词] 社区获得性肺炎；降钙素原；超敏C反应蛋白；老年

[中图分类号] R563 [文献标识码] A [文章编号] 1673-7210（2017）01（b）-0110-04

Application of procalcitonin combined with hypersensitive C reactive protein in evaluate the severity of elder patients with Community-acquired Pneumonia

JIANG Yifei YANG Meng MO Weiqiang

Department of Respiratory Dieases， the Second Hospital of JiaXing， Zhejiang Province， Jiaxing 314000， China

[Abstract] Objective To investigate the clinical value of dectection of serume procalcitonin （PCT） levels combined with hypersensitive C reactive protein （hs-CRP） levels in evaluate the severity of elder patients with community-acquired pneumonia （CAP）. Methods Totally 58 elder patients with CAP admitted and treated in the Second Hospital of Jiaxing from January 2013 to July 2016 were enrolled. They were divided into 3 groups according to CURB-65 scales， with 23 patients in low dangerous group， 18 patients in middle dangerous group and 17 patients in high dangerous group. All patients were detected for serum PCT and hs-CRP. The different concentration of PCT and hs-CRP were compared by Kruscal-Wallis single factor ANOVA multiple sample test， the correlation of CURB-65 scales and concentration of PCT and hs-CRP were analyzed by Spearman correlation analysis. The efficacy of PCT and hs-CRP was evaluated by ROC curve. Results The concentration of PCT and hs-CRP were decreased from high dangerous group to low dangerous group（P < 0.01）. The CURB-65 scales had positive correlation with PCT （r = 0.756， P < 0.01） and hs-CRP（r = 0.745， P < 0.01）. Area under the ROC curve of PCT and hs-CRP were 0.87 and 0.72. Conclusion Detection serume PCT combined with hs-CRP and CURB-65 scales play important roles in evaluate severity of elder patients with CAP.

[Key words] Community-acquired pneumonia； Procalcitonin； Hypersensitive C reactive protein； Elderly

随着人口的老龄化，老年人社区获得性肺炎（CAP）的发病率也随之增高[1-2]。老年病人由于机体免疫力下降，咳嗽、咳痰、发热等典型肺炎症状表现不明显，而往往表现为纳差、乏力、晕厥等情况，导致医生对病情评估产生很大的局限性。目前临床常用CAP评分（CURB-65）、肺炎严重指数（PSI）及急性生理和慢性健康评估（APACH）来评估严重程度及判断预后，但是这些评估均有一定的局限性[3-4]。本研究测试老年CAP患者的降钙素原（PCT），hs-C反应蛋白（CRP）水平，结合CURB-65评分，探讨PCT及hs-CRP在老年CAP患者评估严重程度的临床意义。

1 资料与方法

1.1 一般资料

选择2013年1月～2016年7月嘉兴市第二医院呼吸内科收治的老年CAP患者58例，其中男性31例，女性27例，年龄65～92岁。所有病例均符合中华医学会呼吸学分会《中国成人社区获得性肺炎诊断和治疗指南（2016年版）》[5]的标准。排除标准肺结核、肺部间质性疾病、肺部肿瘤、肺栓塞、肺部肉芽肿性炎、肺水肿等疾病。……