降钙素原对老年社区获得性肺炎诊断价值-内科学专业论文.docxVIP

I I 降钙素原对老年社区获得性肺炎的诊断价值 中文摘要 降钙素原对老年社区获得性肺炎的诊断价值 中文摘要 目的 探讨降钙素原（PCT）对老年社区获得性肺炎的诊断价值。 方法 1. 选择我院2013年7月～2014年1月在呼吸科/老年科就诊的年龄大于60岁的老 年社区获得性肺炎患者178例作为老年CAP组；以我院老年科及体检中心体检的健康 老年人37例为健康老年组；30例健康成年人为健康对照组。 2. 记录CAP组患者一般情况；CAP组治疗前、第4天、第10天检测血清PCT水平； 其他各组于入组后检测血清PCT水平，并进行比较。 结果 1.老年CAP组血清PCT水平高于健康对照组，差异具有统计学意义。 2.老年CAP组死亡患者PCT水平明显高于生存患者（1.46vs0.70，P=0.001）；PCT 水平对老年CAP患者死亡预测ROC曲线下面积0.636，明显高于CRP的0.582。 3.高龄老年CAP患者PCT水平较年轻老年CAP患者低（0.622vs1.006，P=0.035）， 差异显著。 4.PCT水平指导诊断CAP时ROC曲线下面积为0.942，当PCT=0.101时敏感度为 85.4%、特异性为97%。 结论 1. 血清PCT水平对老年CAP患者预后评估有指导意义，PCT水平越高预后越差。 2. 年龄≥75岁的高龄老年人，感染后PCT水平升高幅度较小，可能与老年人IL-2 等细胞因子减少感染后反应性较差有关。 3. 血清PCT用于诊断高龄老年CAP时其截点可能需要相应调整。 4. 动态观察PCT水平对判断预后、指导治疗更有价值。 关键词：社区获得性肺炎；降钙素原；老年 作 者：杨敬业 指导教师：臧国庆 II II Abstract The diagnostic value of serum procalcitonin in the elderly patients with community acquired pneumonia The diagnostic value of serum procalcitonin in the elderly patients with community acquired pneumonia Abstract Objective To compare the usefulness of procalcitonin(PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Methods This study covers 346 CAP cases admitted to Shanghai Jiaotong University attached 6th Hospital between July 2013 and January 2014. Patients were divided into two groups (＞60 years, n=178; ≤60 years, n=168) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, fever，respiratory rate, blood pressure and microbiologic studies. Results Blood cultures were positive in 67 individuals (37.6%) in elderly patients and 69 individuals (41.0%) in adult patients.The levels of procalcitonin were significant higher in infection compared with uninfection (elderly:0.862vs0.068,P＜0.05 ; adult:3.36vs0.068,P ＜0.01 ),and the levels of procalcitonin were significant higher in adult CAP compared with elderly CAP(P＜0.01). The area under the curve for predicting mortality was highest for the PCT (0.636; 95% CI: 0.534-0.737), followed by the area under the curve for WB