[Serum procalcitonin in patients with pulmonary infection and central nervous system injury].

• DOI: 10.3760/cma.j.issn.0376-2491.2017.37.014
• Publication Date: 2017-10-10
• Authors: J C Li; Leijie Wang; Y F Wang; Mu Mei; Linhui Shi; Mengli Yao; Xiaoshan Guan; Bin Ouyang
• Keywords: Procalcitonin; White blood cell; Univariate analysis; Pulmonary infection

Objective: To evaluate the influence of serum procalcitonin in diagnosis and treatment pulmonary infection patients with central nervous system injury. Methods: From October 2014 to February 2017, a retrospective study was performed. A total 1 852 were screened Department Intensive Care Unite, First Affiliated Hospital Sun Yat-sen University.Among them, 173 identified different kinds infection. Finally, 42 enrolled. The clinical data (CNS) injury collected. univariate multivariate regression analysis performed correlation (PCT) symptoms signs infection, body temperature(T), white blood cell count (WBC), percentage neutrophils (NEU) severity (CPIS). relationship PCT type CNS injury, GCS, exogenous glucocorticoid further studied. Results: During period peak 0.83 (0.29, 2.79) μg/L CPIS 5.50 (5.00, 7.00). In 9 patients, less than 0.25 μg/L. 7 ranged from 0.5 12 2 Only 10 had 2-10 4 more There is no between temperature, cell, CPIS. significant differences PCT<0.5 or ≥0.5 regarding However, independent post day (β=0.17, 95% CI (0.02, 0.32), P<0.05). 1.26 (0.47, 2.7) 29.41% within 3 days Serum level 0.23 (0.16, 0.39) μg/L, 77.78% at post-injury. 0.52 (0.33, 1.12) 44.44% 8 14. 3.26 (2.07, 12.40) patient after 15 found disease surgery, use glucocorticoid. Conclusions: increase not able be used guiding antibiotics infection.目的： 探讨血清降钙素原(PCT)在中枢神经系统损伤后肺部感染患者的变化规律与诊治价值。 方法： 回顾分析2014年10月至2017年2月中山大学附属第一医院重症医学科中枢神经系统损伤后患者1 852例，其中各类感染173例，89例临床资料完整，最后纳入确诊中枢神经系统损伤后单纯肺部感染42例。获取患者血清PCT水平、肺部感染临床征像、影像资料以及感染相关实验室指标，采用单因素和多因素线性回归，分析中枢神经系统损伤后患者血清PCT与肺部感染以及肺部感染严重程度(CPIS)的相关性，并进一步分析血清PCT水平是否受中枢神经系统损伤后天数、疾病种类及手术类型、格拉斯哥昏迷评分(GCS)以及外源性糖皮质激素等因素的影响。 结果： 42例患者CPIS 5.50(5.00，7.00)分，血清PCT 0.83(0.29，2.79) μg/L。肺部感染期间血清PCT峰值<0.25 ng/ml 9例，0.25～0.5 7例，0.5～2 12例，2～10 10例，仅4例患者感染期间血清PCT峰值≥ μg/L。血清PCT与体温(T)、血白细胞(WBC)、中性粒细胞(NEU)比值、CPIS评分无显著相关。PCT<0.5与PCT≥0.5 μg/L两组患者的T、WBC、NEU比值、CPIS差异无统计学意义。中枢神经系统损伤后肺部感染患者血清PCT水平与创伤后时间存在独立相关关系[β＝0.19，95%可信区间(0.01，0.36)，P<0.05]；将肺部感染发生时间分为中枢神经系统损伤后0～3、4～7 、8～14与≥15 d，损伤后不同时间段内肺部感染患者的血清PCT峰值差异有统计学意义(P<0.05)，损伤后0～3 d的17例患者感染期间血清PCT峰值1.26(0.47，2.7) μg/L，29.41%的患者PCT<0.5 μg/L，损伤后4～7 d 9例患者感染期间血清PCT峰值0.23(0.16，0.39) μg/L，77.78%的患者PCT<0.5 μg/L，损伤后7～14 9例患者感染期间血清PCT峰值0.52(0.33，1.12) μg/L，PCT<0.5 μg/L患者减少至44.44%，损伤后≥15 7例患者感染期间血清PCT峰值3.26(2.07，12.40) μg/L患者数减少至零。血清PCT与GCS评分、疾病种类及手术类型、外源性糖皮质激素使用未发现明显相关。 结论： 中枢神经系统损伤后肺部感染患者血清PCT水平上升不明显，不能依照PCT指导这类患者的抗生素治疗。.