社区获得性肺炎患者炎症标志物的评估——抗菌药物预处理的影响：德国能力网络 CAPNETZ 的结果。

Assessment of inflammatory markers in patients with community-acquired pneumonia--influence of antimicrobial pre-treatment: results from the German competence network CAPNETZ.

机构信息

Medical Clinic I, Medical Faculty, RWTH University Aachen, Pauwelsstr. 30, D-52057 Aachen, Germany.

出版信息

Clin Chim Acta. 2010 Dec 14;411(23-24):1929-34. doi: 10.1016/j.cca.2010.08.004. Epub 2010 Aug 7.

DOI:10.1016/j.cca.2010.08.004

PMID:20699094

Abstract

BACKGROUND

There is almost no data about the influence of antimicrobial pre-treatment (APT) on levels of inflammatory markers in community acquired pneumonia (CAP). The aim of this study was to investigate the influence of APT on inflammatory markers in CAP.

METHODS

991 hospitalized patients (64.3±17.6 years, 61% male) with CAP were enrolled. In all patients procalcitonin (PCT), C-reactive protein (CRP), and leukocyte count (WBC) were determined. Patients were followed-up for 28 days for survival.

RESULTS

232 patients (23.4%) had APT, 759 had no APT. Patients without APT had significantly higher levels of PCT and WBC but not of CRP compared to those with APT. In patients without APT, survivors compared to non-survivors had lower values of PCT (0.20 ng/mL; 0.02-169.10 vs. 0.83 ng/mL; 0.04-516.30, p<0.0001), WBC (12.4×10(9)/L; 1.3-49.9 vs. 14.9×10(9)/L; 3.7-34.5, p=0.047) and CRP (107.0mg/mL; 0.3-567.0 vs. 143.5mg/mL; 5.0-589.0, p=0.006). However, in patients with APT, the values of PCT, WBC and CRP were not significantly different in survivors and non-survivors. Cox regression analysis confirmed that PCT, CRP and WBC were predictive for 28 day mortality in patients without APT but not in those with APT.

CONCLUSIONS

PCT and WBC but not CRP levels are higher in patients without APT compared to those with APT. PCT, CRP and WBC are predictive for 28 days mortality exclusively in patients without APT. Interpretation of inflammatory parameters has to take into account possible APT.

摘要

背景

抗菌药物预处理（APT）对社区获得性肺炎（CAP）炎症标志物水平的影响几乎没有数据。本研究旨在研究 APT 对 CAP 炎症标志物的影响。

方法

共纳入 991 例住院 CAP 患者（64.3±17.6 岁，61%为男性）。所有患者均测定降钙素原（PCT）、C 反应蛋白（CRP）和白细胞计数（WBC）。对所有患者进行 28 天的生存随访。

结果

232 例（23.4%）患者接受了 APT，759 例患者未接受 APT。与接受 APT 的患者相比，未接受 APT 的患者 PCT 和 WBC 水平显著升高，但 CRP 水平无显著差异。在未接受 APT 的患者中，与存活者相比，非存活者的 PCT 水平较低（0.20ng/ml；0.02-169.10 与 0.83ng/ml；0.04-516.30，p<0.0001），WBC（12.4×10(9)/L；1.3-49.9 与 14.9×10(9)/L；3.7-34.5，p=0.047）和 CRP（107.0mg/ml；0.3-567.0 与 143.5mg/ml；5.0-589.0，p=0.006）。然而，在接受 APT 的患者中，存活者与非存活者的 PCT、WBC 和 CRP 值无显著差异。Cox 回归分析证实，在未接受 APT 的患者中，PCT、CRP 和 WBC 是 28 天死亡率的预测因素，但在接受 APT 的患者中则不是。