血清和胸腔积液降钙素原对肺炎旁胸腔积液病情评估和诊治的临床价值VIP免费

浙江医学2013年第35卷第9期作者单位：310014杭州，浙江省人民医院呼吸科血清和胸腔积液降钙素原对肺炎旁胸腔积液病情评估和诊治的临床价值叶飒严建平王宏任卓超肺炎旁胸腔积液（parapneumonicpleuraleffusion，PPPE）是肺炎常见的并发症，发生率为36%～57%，肺炎合并PPPE者病死率明显高于单纯肺炎患者。按照病情程度不同，PPPE分为单纯性肺炎旁胸腔积液（un-【摘要】目的评价血清降钙素原（S-PCT）和胸腔积液降钙素原（PF-PCT）水平在肺炎旁胸腔积液（PPPE）患者病情评估和诊治中的临床价值。方法80例PPPE患者分为两组：单纯性肺炎旁胸腔积液（UCPE）组42例、复杂性肺炎旁胸腔积液（CPE）组38例，另选定30例漏出液患者作为对照组。检测3组胸腔积液的pH值、葡萄糖、LDH，S-PCT和PF-PCT水平。结果3组胸腔积液的pH值、葡萄糖、LDH均有统计学意义（均P＜0.05）。UCPE组、CPE组S-PCT和PF-PCT均较对照组明显升高（均P＜0.01），UCPE组、CPE组间S-PCT无统计学意义（P＞0.05），UCPE组、CPE组间PF-PCT有统计学意义（P＜0.05）；S-PCT与PF-PCT之间呈正相关性（r=0.70，P＜0.05）。S-PCT与PF-PCT在肺炎严重指数（PSI）评分分层的高风险者明显升高（P＜0.05），住院天数＞3周和发生并发症及死亡者的S-PCT及PF-PCT分别较住院天数＜3周和未发生并发症及死亡者的明显增高，均有统计学意义（均P＜0.05），胸膜增厚者和外科手术者PF-PCT/S-PCT分别较非胸膜增厚者和非外科手术者明显下降，均有统计学意义（均P＜0.05）；PF-PCT＞0.25ng/ml（临界值）时被认为对CPE有诊断意义，敏感度为80%，特异度为76%。结论S-PCT和PF-PCT对PPPE病情评估有临床意义；PF-PCT对CPE有诊断意义，可对临床治疗起到指导作用；PF-PCT/S-PCT可以预测胸膜增厚程度和外科手术率。【关键词】血清降钙素原胸腔积液降钙素原胸腔积液降钙素原/血清降钙素原肺炎旁胸腔积液单纯性肺炎旁胸腔积液复杂性肺炎旁胸腔积液TheclinicalvalueofS-PCTandPF-PCTinevaluationandtreatmentofpatientswithparapneumonicpleuraleffusionChina【Abstract】ObjectiveToinvestigatetheapplicationofserumandpleuralfluidprocalcitonin(S-PCTandPF-PCT)levelsinevaluationofpatientswithparapneumonicpleuraleffusion(PPPE).MethodsEightypatientswithPPPEwereincludedinthestudy,including42casesofuncomplicatedpleuraleffusion(UCPE)and38casesofcomplicatedpleuraleffusion(CPE);30pa-tientswithtransudatepatientsservedascontrols.ThePH,glucoseandlactatedehydrogenase(LHD)levelsinpleuralfluidorintrasnudateaswellasS-PCTandPF-PCTweremeasuredinthreegroups.ResultsThereweresignificantlydifferenceinPH,glucoseandLDHamongthreegroups(P＜0.05).ThelevelsofS-PCTandPF-PCTwerehigherinPPPEpatientsthanthoseincontrols(P＜0.01).TherewerenosignificantlydifferenceinS-PCTlevelsbetweenUCPEandCPEgroups(P＞0.05),butthediffer-enceinPF-PCTlevelswassignificant(P＜0.05).TheS-PCTlevelwaspositivelycorrelatedwithPF-PCTlevelinthreegroups(r=0.70,P＜0.05).BothS-PCTandPF-PCTlevelssignificantlyincreasedinhighriskpatientsclassifiedbythePSIscore(P＜0.05),whosehospitalstay＞3weeks,orinwhomcomplicationsordeathoccurred(P＜0.05).PF-PCT/S-PCTlevelsweresignificantlydecreasedinpatientswhohadpleuralthickeningorneedsurgicalprocedures(P＜0.05).Thecut-offvalueofPF-PCT＞0.25ng/mLwasusedfordiagnosisofCPEwithasensitivityof80%andspecificityof76%.ConclusionThelevelsofS-PCTandPF-PCTcanbeusedinclinicalevaluationofpatientswithPPPE;PF-PCTmaydifferentiateUCPEfromCPE,whichneedthoracicclosingdrainage,thoracicinjectionoffibrinolyticagentsorpossiblethoracoscopicsurgeryfortreatment.【Keywords】S-PCTPF-PCTPF-PCT/S-PCTPPPEUCPECPE747浙江医学2013年第35卷第9期complicatedparapneumoniceffusion,UCPE），复杂性肺炎旁胸腔积液（complicatedparapneumoniceffusion，CPE）和脓胸（pleuralempyema，PE）。...