降钙素原与高敏C反应蛋白联合检测在老年冠心病患者细菌感染中的临床应用

Clinical application of combined detection of procalcitonin and highsensitivity Creactive protein in bacterial infection in elderly patients with coronary heart disease

摘要:

目的比较冠心病患者血液感染性指标的变化，分析降钙素原（PCT）和高敏C反应蛋白(hsCRP)在患者细菌感染中的临床诊断价值。方法选择2013年1月—2014年12月某院收治的冠心病患者，分别于治疗前（D0天）和治疗后第5天（D5）对诊断感染指标PCT、hsCRP、全血白细胞计数（WBC）、中性粒细胞计数（NEU）进行检测，比较细菌感染与非细菌感染组之间的差异，不同部位细菌感染，以及存活组和死亡组之间的差异。结果细菌感染组四项检测指标（PCT、hsCRP、WBC和NEU）均明显高于非细菌感染组；不同感染部位血清PCT和hsCRP水平比较，差异均具有统计学意义（均P<0.001），其中以血流感染患者水平最高［分别为（45.148±46.341）ng/mL、（137.000±87.367）mg/L］，其次是胸腹腔感染和呼吸系统感染，泌尿系统感染患者最低［分别为（0.769±1.747）ng/mL、（53.006±45.450）mg/L］。存活组经治疗后各项检测指标均较治疗前低，而死亡组则不断增高。冠心病合并细菌感染患者血清PCT、hsCRP、WBC和NEU曲线下面积分别是0.934、0.856、0.782和0.784。结论联合检测血清PCT和hsCRP不仅可作为鉴别老年冠心病患者早期细菌感染的有效指标，还可用于病情评估，疗效判断，对评估感染的严重程度以及对患者预后的判断具有重要意义。

Abstract:

ObjectiveTo compare changes in infectious markers in blood of patients with coronary heart disease (CHD), analyze clinical diagnostic value of procalcitonin (PCT) and highsensitivity Creactive protein (hsCRP) in bacterial infection in patients with  CHD. MethodsPatients with CHD admitted to a hospital between January 2013 and December 2014 were studied. PCT, hsCRP, white blood cell (WBC), and neutrophil (NEU) count were detected before treatment and on the 5th day after treatment, differences between bacterial infected group and noninfected group, infection sites, as well as survival and death groups were compared respectively. ResultsSerum levels of PCT,hsCRP,WBC, and NEU in bacterial infected group were all significantly higher than noninfected group; PCT and hsCRP in infection of different sites were statistically significant （all P<0.001）, patients with bloodstream infection had the highest levels (［45.148±46.341］ ng/mL, ［137.000±87.367］mg/L, respectively)，followed by thoracic and abdominal infection,as well as respiratory system infection，while patients with urinary system infection had the lowest levels(［0.769±1.747］ng/mL, ［53.006±45.450］mg/L, respectively). After treatment, makers in survival group were all lower than before treatment, but in death group were all higher than before treatment. The area under the curve of PCT, hsCRP, WBC, and NEU were 0.934, 0.856, 0.782, and 0.784 respectively. ConclusionThe combined detection of PCT and hsCRP is effective for early diagnosis of bacterial infection in elderly patients with CHD, it is also helpful for assessing disease condition, curative efficacy, and prognosis.