Li J C, Wang L Y, Wang Y F, Mei M H, Shi L, Yao M L, Guan X D, Ouyang B
Department of Intensive Care Unite, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Yi Xue Za Zhi. 2017 Oct 10;97(37):2940-2945. doi: 10.3760/cma.j.issn.0376-2491.2017.37.014.
To evaluate the influence of serum procalcitonin in the diagnosis and treatment of pulmonary infection in patients with central nervous system injury. From October 2014 to February 2017, a retrospective study was performed. A total of 1 852 patients were screened in Department of Intensive Care Unite, First Affiliated Hospital of Sun Yat-sen University.Among them, 173 patients were identified with different kinds of infection. Finally, a total of 42 patients with pulmonary infection were enrolled. The clinical data of patients with pulmonary infection and central nervous system (CNS) injury was collected. A univariate and multivariate regression analysis was performed to study the correlation of serum procalcitonin (PCT) with clinical symptoms and signs of the pulmonary infection, body temperature(T), white blood cell count (WBC), percentage of neutrophils (NEU) and the severity of the pulmonary infection (CPIS). The relationship of serum PCT with type of CNS injury, GCS, and exogenous glucocorticoid was further studied. During the period of pulmonary infection, the peak PCT was 0.83 (0.29, 2.79) μg/L and the CPIS was 5.50 (5.00, 7.00). In 9 of 42 patients, the peak PCT was less than 0.25 μg/L. In 7 of 42 patients, the peak PCT was ranged from 0.25 to 0.5 μg/L. In 12 of 42 patients, PCT was ranged from 0.5 to 2 μg/L. Only 10 patients had a PCT 2-10 μg/L and 4 patients had a PCT more than 10 μg/L. There is no correlation between serum PCT and body temperature, white blood cell, percentage of neutrophils and CPIS. There was no significant differences in patients with PCT<0.5 or ≥0.5 μg/L regarding the body temperature, white blood cell, percentage of neutrophils and CPIS. However, serum PCT in patients with pulmonary infection had independent correlation with the post CNS injury day (=0.17, 95% (0.02, 0.32), <0.05). The serum PCT was 1.26 (0.47, 2.7) μg/L and 29.41% patients with a PCT less than 0.5 μg/L within 3 days post CNS injury. Serum PCT level was 0.23 (0.16, 0.39) μg/L, and 77.78% patients with a PCT less than 0.5 μg/L at day 4 to day 7 post-injury. The PCT level was 0.52 (0.33, 1.12) μg/L, and 44.44% patients with a PCT less than 0.5 μg/L at day 8 to day 14. The PCT was 3.26 (2.07, 12.40) μg/L, and no patient with a PCT less than 0.5 μg/L after day 15 post-injury. There were no significant relationship found between serum PCT level and type of the disease and surgery, GCS, and use of exogenous glucocorticoid. Serum PCT had no significant increase and was not able to be used in guiding the antibiotics use in patients with CNS injury and pulmonary infection.
评估血清降钙素原在中枢神经系统损伤患者肺部感染诊断及治疗中的影响。2014年10月至2017年2月，进行了一项回顾性研究。中山大学附属第一医院重症监护病房共筛查1852例患者，其中173例确诊为不同类型感染，最终纳入42例肺部感染患者。收集肺部感染合并中枢神经系统（CNS）损伤患者的临床资料，进行单因素及多因素回归分析，研究血清降钙素原（PCT）与肺部感染临床症状体征、体温（T）、白细胞计数（WBC）、中性粒细胞百分比（NEU）及肺部感染严重程度（CPIS）的相关性，进一步研究血清PCT与CNS损伤类型、格拉斯哥昏迷评分（GCS）及外源性糖皮质激素的关系。肺部感染期间，PCT峰值为0.83（0.29，2.79）μg/L，CPIS为5.50（5.00，7.00）。42例患者中，9例PCT峰值低于0.25μg/L，7例PCT峰值在0.25至0.5μg/L之间，12例PCT在0.5至2μg/L之间，仅10例患者PCT为2 - 10μg/L，4例患者PCT大于10μg/L。血清PCT与体温、白细胞、中性粒细胞百分比及CPIS无相关性。PCT<0.5或≥0.5μg/L的患者在体温、白细胞、中性粒细胞百分比及CPIS方面无显著差异。然而，肺部感染患者血清PCT与CNS损伤后天数呈独立相关（=0.17，95%（0.02，0.32），<0.05）。CNS损伤后3天内，血清PCT为1.26（0.47，2.7）μg/L，29.41%患者PCT低于0.5μg/L；损伤后4至7天，血清PCT水平为0.23（0.16，0.39）μg/L，77.78%患者PCT低于0.5μg/L；损伤后8至14天，PCT水平为0.52（0.33，1.12）μg/L，44.44%患者PCT低于0.5μg/L；损伤后15天以后，PCT为3.26（2.07，12.40）μg/L，无患者PCT低于0.5μg/L。血清PCT水平与疾病类型、手术、GCS及外源性糖皮质激素的使用无显著关系。血清PCT无显著升高，不能用于指导CNS损伤合并肺部感染患者的抗生素使用。
