前降鈣素原、C-反應(yīng)蛋白和臨床肺部感染評分對呼吸機相關(guān)肺炎診斷的意義
發(fā)布時間:2018-12-14 14:57
【摘要】:【目的】探討前降鈣素原(PCT)、C-反應(yīng)蛋白(CRP)和簡化臨床肺部感染評分(CPIS)對呼吸機相關(guān)肺炎(VAP)的診斷效能、相關(guān)性以及聯(lián)合使用的臨床診斷價值!痉椒ā窟x擇廣州中山大學(xué)附屬第一醫(yī)院重癥監(jiān)護病房(ICU)且疑診為VAP的成人患者納入此前瞻性診斷試驗,監(jiān)測入住ICU或氣管插管當日以及疑診VAP當日的PCT、CRP,計算急性生理學(xué)和慢性健康狀況評分Ⅱ(APACHEⅡ)、序貫器官功能障礙評分(SOFA)和簡化CPIS評分,以后每日計算簡化的CPIS評分,每48h復(fù)查PCT、CRP,收集支氣管灌洗物,直至試驗結(jié)束。結(jié)束后計算PCT、CRP、簡化CPIS診斷VAP的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值,繪制上述指標診斷VAP的受試者工作曲線(ROC)并計算曲線下面積(AUC),根據(jù)敏感性、特異性的最佳比值來確定診斷的最佳閾值。【結(jié)果】篩選459例患者進入隨訪流程,最終符合條件者30例,17例通過微生物學(xué)證據(jù)確診VAP,13例臨床上達到疑診標準但缺乏微生物學(xué)證據(jù)而未確診。PCT、CRP、CPIS診斷VAP的AUC值分別為0.735(95%CI:0.536-0.934),0.599(95%CI:0.361-0.838)及0.809(95%CI:0.641-0.976)。PCT以0.685 ng/mL為閾值,診斷敏感性和特異性分別為76.5%和62.5%;CRP以53.65 mg/L為閾值,診斷敏感性和特異性分別為52.9%和62.5%;簡化CPIS以6分為閾值,診斷敏感性和特異性分別為60.5%和92%。PCT≥0.685 ng/mL聯(lián)合簡化CPIS≥6分診斷VAP,敏感性和特異性分別為70.6和100%!窘Y(jié)論】單獨使用CRP檢測對VAP早期診斷無明顯價值;單獨使用PCT檢測對VAP早期診斷具有一定價值;單獨使用簡化CPIS進行VAP早期診斷準確性較好;CRP、PCT和簡化CPIS評分之間均無顯著相關(guān)性;簡化CPIS評分聯(lián)合PCT檢測有助于提高VAP早期診斷特異性,且敏感性并未降低。
[Abstract]:[objective] to investigate the diagnostic efficacy of procalcitonin proto (PCT), C-reactive protein (CRP) and simplified clinical pulmonary infection score (CPIS) in the diagnosis of ventilator-associated pneumonia (VAP). [methods] Adult patients with (ICU) and suspected VAP in intensive care unit of the first affiliated Hospital of Sun Yat-sen University in Guangzhou were included in this prospective diagnostic trial. The PCT,CRP, scores of acute physiology and chronic health status 鈪,
本文編號:2378795
[Abstract]:[objective] to investigate the diagnostic efficacy of procalcitonin proto (PCT), C-reactive protein (CRP) and simplified clinical pulmonary infection score (CPIS) in the diagnosis of ventilator-associated pneumonia (VAP). [methods] Adult patients with (ICU) and suspected VAP in intensive care unit of the first affiliated Hospital of Sun Yat-sen University in Guangzhou were included in this prospective diagnostic trial. The PCT,CRP, scores of acute physiology and chronic health status 鈪,
本文編號:2378795
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