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目的探讨血清C反应蛋白(CRP)水平的变化在社区获得性肺炎(CAP)病情及预后评估中的价值。方法收集CAP患者356例,初诊时和治疗后第4天检测血清CRP水平,观察符合重症肺炎病例数和随访30 d病死率。采用多元回归分析的方法评估预测价值。结果纳入研究范围的356例患者中,符合重症肺炎34例,30 d病死率是7.0%。较低水平的CRP对30 d病死率显示较高的阴性预测值,CRP<100 mg/L是减少重症肺炎(OR 0.22)(P<0.01)和30 d病死率(OR 0.17)(P<0.05)风险的独立危险因素。263例患者第4天重复测量了血清CRP水平。第4天的CRP水平下降少于50%或升高增加重症肺炎(OR 4.9)(P<0.01)和30 d病死率(OR 20.6)(P<0.01)风险。结论 CRP是评估CAP严重程度的独立预测因素。CRP<100 mg/L提示重症肺炎风险和30 d病死率降低。第4天CRP水平下降不足50%或上升提示重症肺炎风险和30 d病死率增加。
Objective To investigate the value of serum C-reactive protein (CRP) level in the assessment of community-acquired pneumonia (CAP) and its prognosis. Methods 356 patients with CAP were collected. Serum CRP levels were measured at the time of first visit and the fourth day after treatment. The results were consistent with the severe pneumonia cases and the 30-day follow-up mortality. Multiple regression analysis was used to assess the forecast value. Results Of the 356 patients enrolled in the study, 34 were eligible for severe pneumonia and the 30-day mortality rate was 7.0%. Lower CRP levels showed a higher negative predictive value at 30 days. CRP <100 mg / L was associated with a reduction of severe pneumonia (OR 0.22) and 30-day mortality (OR 0.17) (P <0.05) The risk of independent risk factors. Serum CRP levels were repeatedly measured on day 4 in 263 patients. On day 4, the CRP level decreased by less than 50% or increased with the increase of severe pneumonia (OR 4.9) (P <0.01) and the 30-day mortality rate (OR 20.6) (P <0.01). Conclusion CRP is an independent predictor of the severity of CAP. CRP <100 mg / L suggests a reduction in the risk of severe pneumonia and a 30-day mortality. A reduction of CRP levels of less than 50% or increase on day 4 suggests an increased risk of severe pneumonia and an increased 30-day mortality.