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目的评估血清降钙素原(procalcitonin,PCT)在重症监护病房机械通气的肺炎患者中的价值。方法采用前瞻性观察研究方法,从2010年1月到2011年9月连续收入首都医科大学附属复兴医院ICU患者中,临床诊断肺炎并进行机械通气的患者,测定入选患者d1～7的血清PCT水平。结果共有111名患者入选,其中社区获得性肺炎(CAP)患者35例,医院获得性肺炎(HAP)37例,呼吸机相关性肺炎(VAP)39例。CAP组患者的基线PCT水平高于VAP组(P﹤0.05)。入选患者的28d病死率为27%,平均ICU住院天数为16d,变化范围(1～135d)。死亡组的PCT水平持续升高,明显高于存活组(P﹤0.05)。基线PCT水平和最高PCT水平与最高SOFA评分具有相关性(r2分别为0.51和0.58)。对于基线PCT水平、最高PCT水平和APACHEⅡ评分,利用受试者工作曲线(ROC曲线)预测患者的28d病死率,曲线下面积分别为0.70、0.74、0.69。基线PCT预测病死率的截断值为1.3ng/ml,最高PCT预测病死率的截断值为5.1ng/ml。结论在ICU中的因重症肺炎(CAP,HAP,VAP)进行机械通气的患者中,PCT水平与疾病的严重程度密切相关,PCT水平可以预测患者28d病死率。
Objective To evaluate the value of serum procalcitonin (PCT) in patients with mechanically ventilated pneumonia in intensive care unit. Methods A prospective observational study was performed to determine the level of serum PCT between d1 and 7 in patients with ICU diagnosed pneumonia and mechanically ventilated from January 2010 to September 2011 in Fuxing Hospital attached to Capital Medical University. . Results A total of 111 patients were included. Among them, 35 were community-acquired pneumonia (CAP), 37 hospital-acquired pneumonia (HAP) and 39 ventilator-associated pneumonia (VAP). The baseline PCT levels in CAP group were higher than those in VAP group (P <0.05). The 28-day mortality rate was 27% for the selected patients and the average ICU stay was 16 days, ranging from 1 to 135 days. PCT levels in the death group continued to increase, significantly higher than the survival group (P <0.05). The baseline PCT level and the highest PCT level correlated with the highest SOFA score (r2 = 0.51 and 0.58, respectively). The baseline PCT level, the highest PCT level, and the APACHE II score were used to predict the 28-day mortality rate using receiver operating curve (ROC curve). The area under the curve was 0.70, 0.74, 0.69 respectively. The cut-off value for baseline PCT predicted mortality was 1.3 ng / ml and the cut-off for the highest PCT predicted mortality was 5.1 ng / ml. Conclusions Among patients with severe pneumonia (CAP, HAP, VAP) undergoing mechanical ventilation in the ICU, the PCT level is closely related to the severity of the disease. The PCT level predicts the 28-day mortality of patients.