CRP和PCT在医院获得性肺炎老年患者中的应用价值

张立娟+++李玉荣++++计龙

[摘要]目的 探讨血清C-反应蛋白（CRP）和降钙素原（PCT）在早期诊断医院获得性肺炎（HAP）老年患者中的临床应用价值。方法 选取2013年11月～2015年12月在我院住院的72例老年HAP患者作为观察组，选取同期体检的65例老年患者作为对照组。观察组于入院时、出现临床表现时、确诊时抽取静脉血检测CRP及PCT水平，对照组于体检当天抽取静脉血检测CRP及PCT水平。比较观察组入院时与对照组的CRP、PCT水平以及观察组出现早期临床表现时与入院时、确诊时的CRP及PCT水平。结果 观察组入院时的CRP和PCT水平与对照组比较，差异无统计学意义（P>0.05）。观察组出现早期临床表现时的CRP和PCT水平高于入院时，差异有统计学意义（P<0.05）。观察组出现早期临床表现时的CRP和PCT水平低于确诊时，差异有统计学意义（P<0.05）。结论 血清CRP与PCT水平在HAP老年患者出现早期临床表现但尚未确诊时即可明显升高，其检测对早期诊断HAP具有较高的临床价值。

[关键词]C-反应蛋白；降钙素原；医院获得性肺炎；老年；早期诊断

[中图分类号] R563.1+9 [文献标识码] A [文章编号] 1674-4721（2016）10（a）-0029-03

[Abstract]Objective To explore the the clinical value of serum C- reactive protein （CRP） and procalcitonin （PCT） in the early diagnosis of hospital acquired pneumonia （HAP） in elderly patients.Methods 72 elderly patients with HAP in our hospital from November 2013 to December 2015 were selected as the observation group，65 normal healthy individuals with the same period were selected as the control group.Blood samples of the observation group were extracted when patients hospitalized and early clinical manifestation arising and diagnosis determined，which of the control group were extracted on the day of physical examination.The level of CRP and PCT was compared between the observation group on admission and the control group，and the level of CRP and PCT in the observation group on admission，early clinical manifestation arising，diagnosis determined was compared.Results There was no significant difference in the serum CRP and PCT levels between the control group and the observation group who hospitalized （P>0.05）.The serum CRP and PCT levels of the observation group when early clinical manifestation arising was higher than that in the same group when patients hospitalized，with significant difference （P<0.05）.The serum CRP and PCT levels of the observation group when early clinical manifestation arising was lower than that in the same group when diagnosis determined，with significant difference （P<0.05）.Conclusion The serum CRP and PCT levels in elderly patients with HAP in early clinical manifestations but not yet confirmed can significantly increase，which have an important clinical significance in early diagnostic value on elderly patients with HAP.

[Key words]C-reactive protein；Procalcitonin；Hospital acquired pneumonia；Elderly patient；Early diagnosis

医院获得性肺炎（hospital acquired pneumonia，HAP）是干诊科及老年病科的常见疾病，是严重影响居民健康的感染性疾病之一，病死率较高[1]。因我科患者均为老年甚至高龄，自身免疫力较弱，住院时间较长，住院期间极易并发HAP，其中细菌感染性肺炎占较高比例，部分患者的临床症状和体征常不典型，若不及时明确诊断，采取有效治疗措施，则病情进展迅速，严重威胁患者生命安全。采用具有高敏感度和特异度的诊断指标在HAP的早期诊断中尤为重要。本研究旨在探讨血清降钙素原（PCT）和C-反应蛋白（CRP）在早期诊断老年HAP中的临床应用价值。

1资料与方法

1.1一般资料

采用前瞻性研究方法，选取2013年11月～2015年12月我科确诊的72例老年医院获得性细菌性肺炎患者作为观察组，另外随机抽取同期在我院干诊科体检的65例老年患者作为对照组。观……