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目的 探讨降钙素原 (procalcitonin, PCT) 和内毒素 (endotoxin, ET) 检测在小儿感染性肺炎中的诊断价值.方法 选择感染性肺炎患儿100例, 其中衣原体肺炎8例, 支原体肺炎14例, 病毒性肺炎23例, 细菌性肺炎55例.另选取45例健康体检儿童为对照组.比较各组血清PCT和ET水平, 对细菌性肺炎患儿痰液标本分离菌株进行鉴定和药敏试验.结果 细菌性肺炎组患儿血清PCT和ET分别为 (10.93±3.07) ng/ml和 (0.26±0.07) EU/ml, 与健康对照组 (0.23±0.14) ng/ml和 (0.04±0.02EU/ml) 比较差异均有统计学意义 (P<0.05);与衣原体肺炎组、支原体肺炎组及病毒性肺炎组PCT (0.24±0.12) ng/ml～0.29±0.18ng/ml和ET (0.04±0.02) EU/ml～0.05±0.03EU/ml比较差异均有统计学意义 (P<0.05), 其中革兰阴性菌组血清ET水平显著高于革兰阳性菌组 (P0.05) .55例细菌性肺炎患儿痰标本中分离出73株病原菌, 其中革兰阴性菌45株, 占61.64％.革兰阴性菌中的肺炎克雷伯菌和大肠埃希菌对氨苄西林耐药率在90％以上, 对头孢呋辛和头孢噻肟耐药率在30％以上.革兰阳性菌28株, 占38.36％, 其中的金黄色葡萄球菌和肺炎链球菌对青霉素耐药率在77％以上, 对红霉素耐药率在58％以上.结论 细菌性肺炎患儿血清PCT和ET升高, 因此可通过血清PCT和ET检测鉴别儿童感染性肺炎的致病菌种类.临床医师应根据病原菌的耐药状况及时选用敏感性药物治疗, 以减少重症肺炎的发生.“,”Objective To investigate the diagnostic value of procalcitonin (PCT) and endotoxin (ET) in children with infectious pneumonia. Methods Subjects were 100 children with infectious pneumonia, including 8 with chlamydial pneumonia, 14 with mycoplasma pneumonia, 23 with viral pneumonia, and 55 with bacterial pneumonia.Forty-five healthy children served as the control group.The levels of serum PCT and ET in each group were compared, and strains found in sputum from children with bacterial pneumonia were identified and tested for susceptibility. Results Serum PCT and ET were 10.93±3.07 ng/ml and 0.26±0.07 EU/ml in children with infectious pneumonia compared to 0.23±0.14 ng/ml and 0.04±0.02 EU/ml in the healthy control group, and levels of serum PCT and ET differed significantly (P<0.05).Levels of serum PCT and ET differed significantly from those (0.24±0.12-0.29±0.18 ng/ml for PCT, 0.04±0.02-0.05±0.03 EU/ml for ET) in the chlamydial pneumonia group, the mycoplasma pneumonia group, the and viral pneumonia group (P<0.05).The serum ET level in the Gram-negative bacteria group was significantly higher than that in the Gram-positive bacteria group (P0.05).Seventy-three pathogens were isolated from sputum from 55 children with bacterial pneumonia.Pathogens included 45 strains of Gram-negative bacteria (61.64％).The resistance of Klebsiella pneumoniae and Escherichia coli to ampicillin was higher than 90％, and their resistance to cefuroxime and cefotaxime was higher than 30％.Pathogens included 28 strains of Gram-positive bacteria (38.36％).The resistance of Staphylococcus aureus and Streptococcus pneumoniae to penicillin was higher than 77％, and their resistance to erythromycin was higher than 58％. ConclusionSerum PCT and ET levels were higher in children with bacterial pneumonia, so serum PCT and ET levels can be used to identify pathogenic bacteria causing infective pneumonia in children.Clinicians should select drugs depending on the susceptibility of pathogens so as to reduce the occurrence of severe pneumonia.