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目的探讨老年社区获得性肺炎(CAP)患者血清D-二聚体、C反应蛋白(CRP)和降钙素原(PCT)水平变化及其与疾病程度的相关性。方法选择2011年5月至2012年5月收治的150例CAP患者,根据其肺炎严重指数(PSI)分级分为低危、中危、高危三组,根据CURB-65分级分为Ⅰ、Ⅱ、Ⅲ组三组,根据重症肺炎标准评定分为重症肺炎组与非重症肺炎组。比较不同组别患者血清D-二聚体、CRP和PCT水平差异及其与CAP的相关性。结果与低危组相比,中、高危组患者的D-二聚体、CRP和PCT水平均显著增高(P均<0.05);相比Ⅰ组,Ⅱ、Ⅲ组患者的D-二聚体、CRP和PCT水平也显著增高(P均<0.05);重症肺炎组的D-二聚体、CRP和PCT水平分别为(2 468.55±747.40)ng/ml、(125.88±47.32)mg/L和(1.59±0.78)ng/ml,显著高于非重症肺炎组的(1 108.36±545.05)ng/ml、(67.39±32.09)mg/L和(0.47±0.20)ng/ml(P均<0.05)。CAP患者的D-二聚体、CRP和PCT水平与CAP疾病严重程度均呈正相关(r=0.32,P<0.01;r=0.48,P<0.01;r=0.38,P<0.01)。结论 D-二聚体、CRP和PCT水平与CAP疾病程度具有正相关性。血清D-二聚体、CRP和PCT水平的测定对CAP具有一定的临床诊断价值。
Objective To investigate the changes of serum D-dimer, C-reactive protein (CRP) and procalcitonin (PCT) in elderly patients with community-acquired pneumonia (CAP) and its relationship with disease severity. Methods A total of 150 patients with CAP who were admitted to our hospital from May 2011 to May 2012 were divided into three groups according to their severity of pneumonia (PSI): low-risk, middle-risk and high-risk. According to CURB-65 classification, Group Ⅲ three groups, according to criteria for severe pneumonia were divided into severe pneumonia group and non-severe pneumonia group. The differences of serum D-dimer, CRP and PCT levels and their correlation with CAP in different groups were compared. Results Compared with low-risk group, the levels of D-dimer, CRP and PCT were significantly increased in moderate and high risk group (all P <0.05). Compared with those in group Ⅰ, D-dimer (P <0.05). The levels of D-dimer, CRP and PCT in severe pneumonia group were (2 468.55 ± 747.40) ng / ml, (125.88 ± 47.32) mg / L and (1.59 ± 0.78) ng / ml, which were significantly higher than those in non-severe pneumonia group (108.36 ± 545.05 ng / ml, 67.39 ± 32.09 mg / L and 0.47 ± 0.20 ng / ml, respectively . The levels of D-dimer, CRP and PCT in CAP patients were positively correlated with the severity of CAP disease (r = 0.32, P <0.01; r = 0.48, P <0.01; r = 0.38, P <0.01). Conclusion D-dimer, CRP and PCT levels have a positive correlation with the degree of CAP disease. Serum D-dimer, CRP and PCT levels in the determination of CAP has some clinical diagnostic value.