【摘要】：[目的]通過(guò)觀察肺栓塞(pulmonary embolism, PE)患者發(fā)熱情況以及實(shí)驗(yàn)室檢查指標(biāo):降鈣素原(procalcitonin,PCT)、白介素-6(interleukin-6,IL-6)、超敏 C 反應(yīng)蛋白(High sensitive c-reactive protein,hs-CRP)水平,探索PE患者發(fā)熱的臨床特點(diǎn)及可能機(jī)制。[方法]回顧性分析昆明醫(yī)科大學(xué)第二附屬醫(yī)院2015年3月至2016年10月于呼吸內(nèi)科一病區(qū)住院經(jīng)256層螺旋CT肺動(dòng)脈造影明確診斷為PE患者305例,篩選出PE合并發(fā)熱患者59例作為實(shí)驗(yàn)組(A組),隨機(jī)選取不合并發(fā)熱的PE患者59例(B組)、同期住院的有發(fā)熱癥狀的社區(qū)獲得性肺炎(Community acquired pneumonia,CAP)患者 59 例(C 組)作為對(duì)照組。所有患者均是在入院當(dāng)時(shí)立即測(cè)體溫,抽取外周靜脈血進(jìn)行PCT、IL-6、hs-CRP的檢測(cè),比較三組患者入院時(shí)的體溫(temperature,T)、PCT、IL-6、hs-CRP水平的差異。并且采用簡(jiǎn)化版的肺栓塞嚴(yán)重程度指數(shù)(Simplfied Pulmonary Embolism Severity Idex,SPESI)評(píng)分對(duì) PE 發(fā)熱患者進(jìn)行危險(xiǎn)程度評(píng)分,評(píng)估體溫與PE危險(xiǎn)程度的關(guān)系。[結(jié)果]1.在305例肺栓塞患者中,由肺栓塞本身引起發(fā)熱者59例(19.3%),體溫范圍在37. 2℃-39. 7℃之間,其中低熱患者44.1%,中等程度發(fā)熱患者37. 3%,高熱患者18. 6%;發(fā)熱程度在PE低危、高危程度的分布,無(wú)統(tǒng)計(jì)學(xué)差異(P0. 05)。2.A、C組的T、PCT、IL-6、hs-CRP水平均明顯高于B組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。C組T較A組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05); A、C組PCT、IL-6、hs-CRP水平比較,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]1.19. 3%的肺栓塞患者可出現(xiàn)發(fā)熱,發(fā)熱以低、中熱為主;發(fā)熱程度與PE的危險(xiǎn)程度無(wú)關(guān)。2.肺栓塞發(fā)熱患者的體溫明顯低于CAP患者;肺栓塞發(fā)熱患者的降鈣素原、白介素6、超敏C反應(yīng)蛋白水平均較不發(fā)熱患者明顯升高,與社區(qū)獲得性肺炎發(fā)熱患者相比較,無(wú)明顯差異。肺栓塞患者發(fā)熱的機(jī)制可能為炎癥反應(yīng)過(guò)程。
[Abstract]:[objective] to explore the clinical characteristics and possible mechanism of fever in patients with pulmonary embolism (pulmonary embolism, PE) by observing the levels of procalcitonin (procalcitonin,PCT), IL-6 (interleukin-6,IL-6) and high-sensitive C-reactive protein (High sensitive c-reactive protein,hs-CRP) in patients with pulmonary embolism. [methods] from March 2015 to October 2016, 305 patients with PE were diagnosed by 256slice spiral CT pulmonary angiography in the second affiliated Hospital of Kunming Medical University. 59 patients with PE complicated with fever were selected as experimental group (group A). 59 patients with PE without fever (group B) were randomly selected. (Community acquired pneumonia, with fever symptoms was hospitalized at the same time. 59 patients with CAP (group C) served as control group. All patients measured their body temperature immediately at the time of admission, and peripheral venous blood was taken for PCT,IL-6,hs-CRP detection. The differences of body temperature (temperature,T) and PCT,IL-6,hs-CRP level among the three groups at admission were compared. The simplified pulmonary embolism severity index (Simplfied Pulmonary Embolism Severity Idex,SPESI) score was used to evaluate the risk degree of PE febrile patients, and the relationship between body temperature and PE risk was evaluated. [result] 1. Of 305 patients with pulmonary embolism, 59 (19.3%) had fever caused by pulmonary embolism itself, with a temperature range of 37. 5%. 2 鈩，

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