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2020 年5 期 第28 卷

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降钙素原对卒中相关性肺炎患者经验性抗感染治疗效果的预测价值研究

Predictive value of procalcitonin on the effect of experiential anti-infection therapy inpatients with stroke-associated pneumonia

作者:张影影1 ,邹琪 2 ,路坤 2 ,李有中 1 ,钱伟东 3

单位:
1.233040 安徽省蚌埠市,蚌埠医学院第二附属医院神经内科 ;2.233004 安徽省蚌埠市,蚌埠医学院第一附属医院重症医学科;3.233004 安徽省蚌埠市,蚌埠医学院第一附属医院神经内科;通信作者:钱伟东,E-mail:lukunde@126.com
关键词:
肺炎;降钙素原;临床肺部感染评分;预测价值
关键词(英文):
Pneumonia;Procalcitonin;Clinical pulmonary infection score;Predictive value
中图分类号:
R 563.1
DOI:
DOI:10.3969/j.issn.1008-5971.2020.05.010
基金项目:
安徽高校自然科学研究项目(KJ2018A0244)

摘要:

背景 卒中相关性肺炎(SAP)是脑卒中常见并发症之一,降钙素原(PCT)在肺炎、脓毒症等细菌感染性疾病诊疗中具有较高的应用价值,但其对 SAP 患者疗效和预后的判断研究相对较少。目的 探讨 PCT 对 SAP患者经验性抗感染治疗效果的预测价值。方法 选取 2018 年 12 月—2019 年 11 月蚌埠医学院第二附属医院神经内科收治的 SAP 患者 44 例,根据经验性抗感染治疗第 7 天临床肺部感染评分(CPIS)分为缓解组(CPIS<6 分,n=32)和加重组(CPIS ≥ 6 分,n=12)。比较两组患者治疗第 1、2、3 天同一时间点(分别记为 D1、D2、D3)血清 PCT 水平及 D2、D3 血清 PCT 水平变化率,并绘制受试者工作特征(ROC)曲线以评价不同时间点血清 PCT 水平及血清 PCT水平变化率对 SAP 患者经验性抗感染治疗效果的预测价值。结果 缓解组患者 D3 血清 PCT 水平低于加重组,血清PCT 水平变化率高于加重组(P<0.05);两组患者 D1、D2 血清 PCT 水平及 D2 血清 PCT 水平变化率比较,差异无统计学意义(P>0.05)。ROC 曲线分析显示,D1、D2、D3 血清 PCT 水平预测 SAP 患者经验性抗感染治疗效果的曲线下面积(AUC)分别为 0.447〔95%CI(0.270,0.683)〕、0.684〔95%CI(0.506,0.861)〕、0.901〔95%CI(0.812,0.991)〕;D2、D3 血清 PCT 水平变化率预测 SAP 患者经验性抗感染治疗效果的 AUC 分别为 0.617〔95%CI(0.436,0.789)〕、0.985〔95%CI(0.906,1.000)〕。结论 治疗第 3 天的血清 PCT 水平及其变化率对 SAP 患者经验性抗感染治疗效果具有较高的预测价值。

英文摘要:

Backgroud Stroke-associated pneumonia(SAP) is one of the common complications of stroke,procalcitonin(PCT) has high application value in the diagnosis and treatment of bacterial infection diseases such aspneumonia,sepsis,however there are relatively few researches on the judgment of curative effect and prognosis of SAP patients.Objective To investigate the predictive value of PCT on the effect of experiential anti-infection therapy in patients with SAP.Methods 44 cases of SAP patients admitted in Department of Neurology,the Second Affiliated Hospital of Bengbu MedicalCollege from December 2018 to November 2019 were selected,and they were divided into relief group(CPIS<6,n=32)and aggravate group(CPIS ≥ 6,n=12) according to the CPIS on the seventh day of empirical anti-infection therapy.Theserum PCT level at the same time point(D1,D2 and D3,respectively) on the first,second and third day after treatment andthe change rate of serum PCT at D2,D3 were compared between the two groups,and ROC curve was drawn to evaluate thepredictive value of serum PCT level and change rate of serum PCT at different time points on experiential anti-infection therapyeffect in patients with SAP.Results Serum PCT level in D3 of relief group was lower than that in aggravate group,the changerate of serum PCT in D3 of relief group was higher than that in aggravate group(P<0.05);there was no significant differencein serum PCT level in D1,D2 or change rate of serum PCT in D2 between the two groups(P>0.05). ROC curve analysisshowed that,AUC of serum PCT level in D1,D2,D3 in predicting the experiential anti-infection therapy effect in patients withSAP was 0.447〔95%CI(0.270,0.683)〕,0.684〔95%CI(0.506,0.861)〕,0.901〔95%CI(0.812,0.991)〕,respectively;AUC of change rate of serum PCT in D2,D3 in predicting the experiential anti-infection therapy effect in patientswith SAP was 0.617〔95%CI(0.436,0.789)〕,0.985〔95%CI(0.906,1.000)〕,respectively.Conclusion Theserum PCT level and change rate of serum PCT on the third day have a high predictive value on the empirical anti-infectiontherapy effect of SAP patients.

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