本文關(guān)鍵詞： 社區(qū)獲得性肺炎 生物學(xué)指標(biāo) 嚴(yán)重程度 ICU治療 預(yù)后　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究生物學(xué)指標(biāo)降鈣素原(Procalcitonin,PCT),白細(xì)胞計(jì)數(shù)(White Blood Count,WBC),C反應(yīng)蛋白(C Reactive Protein,CRP)與社區(qū)獲得性肺炎社區(qū)獲得性肺炎(community acquired pneumonia,CAP)嚴(yán)重程度之間的關(guān)系,以及上述三種生物學(xué)指標(biāo)在判斷CAP患者是否需要進(jìn)入ICU治療及預(yù)后的診斷價值。方法:收集2015年9月至2016年9月皖南醫(yī)學(xué)院弋磯山醫(yī)院收治的CAP患者70例其中包括呼吸內(nèi)科收治的CAP患者40例,重癥醫(yī)學(xué)科(ICU)收治的CAP換30例所有患者診斷符合《中國成人社區(qū)獲得性肺炎診斷及治療指南2016版》中指定的診斷標(biāo)準(zhǔn)。同時,應(yīng)用SPSS19.0統(tǒng)計(jì)軟件分析該上述生物學(xué)指標(biāo)與患者臨床資料之間的關(guān)系。結(jié)果:入院時患者情況根據(jù)CURB-65評分分為低中高危三組。其中高危組患者的住院天數(shù)(38±30天)明顯高于低危組(13±10天)中危組(14±8天),高危組PCT(6.5±1.7),白細(xì)胞計(jì)數(shù)(12.8±5.2)數(shù)高于中危組白細(xì)胞計(jì)數(shù)(11.5±2.9)PCT(5.5±0.2)及低危組白細(xì)胞計(jì)數(shù)(9.9±2.1)PCT(5.5±0.2),經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05)上述三組患者中PCT水平存在明顯差異,高危組患者PCT水平高于中危組及低危組。根據(jù)Spearman相關(guān)性分析其中患者PCT水平與患者CRUB65評分嚴(yán)重程度呈正相關(guān)(Spearman=0.788)且具有統(tǒng)計(jì)學(xué)意義P0.05ICU治療組患者住院天數(shù)42±32天明顯高于非ICU治療組。ICU治療組患者白細(xì)胞計(jì)數(shù)(12.5±5.2)及PCT水平(6.8±1.7)高于非ICU治療組患者白細(xì)胞計(jì)數(shù)(10.9±3.2)及PCT水平(5.0±2.0),上述兩組之間生物學(xué)標(biāo)志物水平差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。PCT,WBC,CRP對于判斷患者是否需要進(jìn)入ICU治療受試者工作特征曲線下面積(ROC-AUC)分別為0.958,0573,0.592經(jīng)比較發(fā)現(xiàn)PCT受試者工作特征曲線下面積高于CRP和WBC,表明PCT在判斷患者是否需要進(jìn)入ICU治療具有更高的診斷價值。死亡組患者年齡76±19,PCT7.3±2.1,白細(xì)胞計(jì)數(shù)14.0±6.6(WBC)水平高于存活組年齡66±14歲,PCT5.4±1.9mg/L,白細(xì)胞計(jì)數(shù)11.2±3.5ug/ml并具有統(tǒng)計(jì)學(xué)意義(P0.05),而存活組和死亡組CRP的水平差異則無明顯統(tǒng)計(jì)學(xué)意義。PCT,WBC,CRP對于判斷患者轉(zhuǎn)歸(是否死亡)治療受試者工作特征曲線下面積(ROC-AUC)分別為0.861,0.584,0.693經(jīng)比較發(fā)現(xiàn)PCT受試者工作特征曲線下面積高于(ROC-AUC)CRP和WBC,表明PCT在判斷患者預(yù)后診斷價值更高。結(jié)論:PCT,CRP,WBC在判斷CAP患者嚴(yán)重程度上具有診斷學(xué)意義,其中PCT與CAP患者嚴(yán)重程度相關(guān)性最高具有明顯診斷價值。在預(yù)測患者是否進(jìn)入ICU治療以及患者預(yù)后PCT較CRP,WBC診斷價值更高。
[Abstract]:Objective: to study the relationship between the biological index Procalcitonin Blood, white blood cell count (WBC) and the severity of community acquired pneumonia (acquired) community pneumoniae pneumoniae (acquired). And the diagnostic value of the above three biological indexes in judging whether CAP patients need to enter ICU treatment and prognosis. Methods: from September 2015 to September 2016, 70 cases of CAP patients admitted to Yiji Mountain Hospital of Southern Anhui Medical College were collected. Including 40 patients with CAP treated in Department of Respiratory Medicine, The diagnosis of 30 patients with CAP met the criteria specified in the guidelines for the diagnosis and treatment of Adult Community acquired pneumonia in China (2016). At the same time, SPSS19.0 statistical software was used to analyze the relationship between the above biological indexes and the clinical data. Results: according to the CURB-65 score, the patients were divided into three groups of low, middle and high risk. The hospitalization days of the patients in the high risk group were 38 鹵30 days. It was significantly higher than that in the low risk group (14 鹵8 days), the high risk group (PCT(6.5 鹵1.7) and the white blood cell count (12.8 鹵5.2) were significantly higher than those in the middle risk group (11.5 鹵2.9) and the low-risk group (5.5 鹵2.1) and the white blood cell count (5.5 鹵0.2) was significantly higher than that in the low risk group. There was significant difference in PCT level among the three groups. The level of PCT in high risk group was higher than that in middle risk group and low risk group. According to Spearman correlation analysis, there was a positive correlation between PCT level and CRUB65 score (0.788). The white blood cell count (WBC) and PCT level in ICU group were significantly higher than those in non ICU group (10. 9 鹵3. 2) and PCT (5. 0 鹵2. 0), respectively. There was significant difference between these two groups in the level of biological markers (P 0. 05???)? The area under the operating characteristic curve of patients who need to enter the ICU treatment is 0.958 / 0573U / AUC = 0.958 / 0573U / 0.592, respectively. The comparison shows that the area under the operating characteristic curve of PCT subjects is higher than that of CRP and WBC, indicating that PCT is used to judge whether the patients need to enter ICU therapy or not. The age of the patients in the death group was 76 鹵19 PCT 7.3 鹵2.1, and the white blood cell count was 14.0 鹵6.6 渭 g / L, which was higher than that in the survival group, which was 5.4 鹵1.9 mg / L, and the white blood cell count was 11.2 鹵3.5 ugr / ml and had statistical significance (P 0.05). However, there was no significant difference between the survival group and the death group in CRP level. The area under the operating characteristic curve of PCT patients is 0.861 ~ 0.584 ~ 0.693 respectively. It is found that the area under the operating characteristic curve of PCT subjects is higher than that of ROC-AUC and WBC, indicating that PCT is used to judge the patients. Conclusion the diagnostic value of CAP is significant in judging the severity of CAP. The highest correlation between PCT and the severity of CAP is of great diagnostic value, and the diagnostic value of PCT in predicting the entry of ICU and the prognosis of PCT is higher than that of CAP.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.1

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