降钙素原对感染性心膜炎诊疗价值.docVIP

降钙素原对感染性心膜炎诊疗价值 　　DOI：10.3760/cma.j.issn.1671-0282.2013.08.025 基金项目：辽宁省自然科学基金项目（2013021091） 作者单位：110001 沈阳，中国医科大学附属第一医院感染病科 通信作者： 张静萍， Email：Zjp809302@ 【摘要】目的探讨降钙素原（PCT）对感染性心内膜炎（IE）的诊疗价值。方法回顾性分析中国医科大学第一附属医院感染病科2010年6月至2012年6月确诊的20例血培养阳性感染性心膜炎患者的临床资料。结果死亡组患者入院时的CRP、PCT和治疗5 d后的PCT质量浓度明显高于存活组患者，死亡组患者的CRP、PCT治疗前后的下降程度明显低于存活组。金黄色葡萄球菌IE和阴性杆菌IE的CRP、PCT质量浓度明显高于草绿色链球菌IE和粪肠球菌IE，PCT2 μg/ml多见于金色葡萄球菌（金球菌）和阴性杆菌感染。结论降钙素原（PCT）与C-反应蛋白（CRP）在评价感染性心内膜炎（IE）病情严重程度和抗感染治疗效果等方面具有临床指导意义，在评估预后方面PCT略优于CRP；降钙素原的测定水平对感染性心内膜炎菌种有提示意义，有利于指导早期抗菌药物治疗。 【关键词】降钙素原；心内膜炎；C-反应蛋白；金黄色葡萄球菌；诊断；治疗；预后；手术 The value of procalcitonin in the diagnosis and treatment of infective endocarditis patients ZHANG Qian， ZHANG Jing-ping. Department of Infectious Diseases， First Affiliated Hospital of China Medical University， Shenyang， 110001， China Corresponding author：ZHANG Jing-ping， Email：Zjp809302@ 【Abstract】ObjectiveTo evaluate the role of procalcitonin （PCT） in the diagnosis and treatment of infective endocarditis （IE）. MethodsIt was a retrospective study of 20 cases diagnosed as IE with positive culture between June 2010 and June 2012 of First Affiliated Hospital of China Medical University， Department of Infectious Diseases. ResultsThe concentration of C-Reactive Protein （CRP） and PCT in the dead group recorded on the first day and the fifth day in the treatment was significant higher than the survival group. The decreased degree of CRP and PCT concentration after treatment in the dead group was much deeper than the survival group. Moreover， the concentration of CRP and PCT in Staphylococcus aureus IE and negative bacilli IE were significant higher than Streptococcus viridans IE or Enterococcus faecalis IE， which was commonly above 2 μg/ml level. ConclusionsSerum procalcitonin， lined with CRP， has the similar significance in the assessment of infective endocarditis severity， however， PCT is slightly better than CRP in assessing prognosis. The concentration of procalcitonin has implications to