急性心力衰竭合并感染患者降鈣素原及C反應(yīng)蛋白水平變化的臨床意義

[摘要] 目的 探討在急性心力衰竭合并感染患者中血清降鈣素原（PCT）及C反應(yīng)蛋白（CRP）水平變化的臨床意義。方法整群選擇2014年1月—2015年12月于該院就診的急性心力衰竭患者共129例，分為心力衰竭合并感染組71例，單純心力衰竭組58例，另選擇健康體檢者30名為正常對(duì)照組。檢測(cè)所有受試者血清中降鈣素原及C反應(yīng)蛋白水平，對(duì)檢測(cè)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)處理并分析。結(jié)果 心力衰竭合并感染組PCT及CRP明顯高于單純心力衰竭組及正常對(duì)照組（P <0.01）；而單純心力衰竭組PCT及CRP明顯高于正常對(duì)照組（P <0.01）。PCT及CRP與合并感染均成正相關(guān)。PCT的最佳診斷界值為0.71 ng/mL，敏感度為75.9%，特異度為89.5%；CRP的最佳診斷界值為38.3 mg/L，敏感度為87.1%，特異度為69.2%。結(jié)論 聯(lián)合檢測(cè)PCT及CRP可為急性心衰合并感染患者的早期診斷、早期治療提供有力證據(jù)。

[關(guān)鍵詞] 急性心力衰竭；感染；降鈣素原；C反應(yīng)蛋白

[中圖分類號(hào)] R576 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-0742（2016）10（b）-0036-03

[Abstract] Objective To evaluate The clinical significance of procalcitonin （PCT） and C-reactive protein（CRP） level change in Patients with acute heart failure co-infection. Methods Group selection 129 cases patients with acute heart failure from January 2014 to December 2015 in our hospital were collected.The patients were divided into acute heart failure combined infection group and merely acute heart failure group.30 cases healthy controls were selected as control group.The serum procalcitonin and C-reactive protein of all the subjects were detected，and the results were analyzed statistically.Results The levels of PCT and CRP in heart failure combined infection group was obviously higher than that of merely heart failure group and normal control group （P < 0.01）. And the levels of PCT and CRP in merely heart failure group was obviously higher than that of normal control group （P < 0.01）. In patients with acute heart failure，PCT and CRP with infection is Positive correlation to both relationship. The best truncation point of PCT was 0.71 ng/mL，the sensitivity was 75.9% and the specificity was 89.5%.The best truncation point of CRP was 38.3 mg/L，the sensitivity was 87.1% and the specificity was 69.2%. Conclusion The combined detection of PCT and CRP provide favorable evidence for early diagnosis and early treatment of patients with acute heart failure combined infection.

[Key words] Acute heart failure；Infection；Procalcitonin；C-reactive protein

急性心力衰竭是指心衰癥狀及體征迅速發(fā)生或惡化，近年來已經(jīng)成為年齡>65歲患者住院的常見原因，且預(yù)后較差，住院病死率為3%，6個(gè)月的再住院率為50%[1]。合并感染為急性心衰的主要誘發(fā)因素之一，因此早期識(shí)別及積極控制感染，對(duì)于急性心衰患者的預(yù)后有重要影響。降鈣素原（procalcitonin，PCT）及C反應(yīng)蛋白（C-reactive protein，CRP）作為快速檢測(cè)感染性疾病的炎癥指標(biāo)已經(jīng)在臨床得到廣泛的研究及應(yīng)用[2-3]。該研究通過探討分析急性心力衰竭患者降鈣素原及C反應(yīng)蛋白水平變化與是否合并感染的關(guān)系，為臨床醫(yī)生判斷病情及合理應(yīng)用抗生素提供依據(jù)，現(xiàn)報(bào)道如下。……