摘要 目的 探讨血清降钙素原（PCT）、C-反应蛋白（CRP）及白细胞介素-6（IL-6）对老年重型脑外伤患者肺部感染的预测价值。 方法 选取2015年1月至2017年12月海南省第三人民医院收治的老年重型脑外伤患者172例，根据其是否发生肺部感染分为感染组（81例）和非感染组（91例），比较两组入院第1、3、5天血清PCT、CRP及IL-6水平变化。应用受试者工作特征（ROC）曲线分析各时间点血清PCT、CRP及IL-6水平对肺部感染的预测价值。 结果 感染组第3天、第5天血清PCT、CRP及IL-6水平明显高于非感染组［PCT（ng/mL）：0.97±0.65 vs. 0.62±0.28，2.41±1.26 vs. 0.48±0.17；CRP（mg/L）：88.63±15.41 vs. 74.50±12.28，92.48±〖JP2〗18.74 vs. 62.38±9.51；IL-6（ng/L）：85.62±22.37 vs. 64.38±16.50，94.26±28.50 vs. 57.30±12.48，均P<0.05］，且感染组第3天、第5天血清PCT、CRP及IL-6水平明显高于第1天［血清PCT（ng/mL）：0.97±0.65和2.41±1.26 vs. 0.60±0.31，CRP（mg/L）：88.63±15.41和92.48±18.74 vs. 67.24±10.25，IL-6（ng/L）：85.62±22.37和94.26±28.50 vs. 54.83±12.16，均P<0.05］。ROC曲线显示，第3天血清PCT、CRP及IL-6联合预测老年重型脑外伤患者肺部感染的AUC（95%CI）为0.904（0.845～0.966）明显高于单项血清PCT第3天［0.826（0.768～0.887）］、CRP第3天［0.805（0.748～0.865）］及IL-6第3天［0.773（0.715～0.835）］，其敏感度和特异度为90.6%和85.2%。 结论 入院第3天血清PCT、CRP及IL-6联合预测老年重型脑外伤患者肺部感染的价值最大。
肖华，卓芬，黄娟娟，蔡月红. 血清PCT CRP及IL-6对老年重型脑外伤患者肺部感染的预测价值[J]. 中国急救医学, 2019, 39(1): 20-24.
Xiao Hua, Zhuo Fen, Huang Juan-juan, Cai Yue-hong. Predictive value of serum PCT, CRP and IL-6 on lung infection in elderly patients with severe brain injury. Chinese Journal of Critical Care Medicine, 2019, 39(1): 20-24.
［1］Leijdesdorff HA, van Dijck JT, Krijnen P, et al. Injury pattern, hospital triage, and mortality of 1250 patients with severe traumatic brain injury caused by road traffic accidents［J］. J Neurotrauma, 2014, 31(5): 459-465.
［2］Wirz Y, Branche A, Wolff M, et al. Management of Respiratory Infections with Use of Procalcitonin: Moving toward More Personalized Antibiotic Treatment Decisions［J］. ACS Infect Dis, 2017, 3(12): 875-879.
［3］Kang KT, Son DW, Lee SH, et al. Variation of C-Reactive Protein and White Blood Cell Counts in Spinal Operation: Primary Fusion Surgery Versus Revision Fusion Surgery［J］. Korean J Spine, 2017, 14(3): 66-70.
［4］Mirzarahimi M, Barak M, Eslami A, et al. The role of interleukin-6 in the early diagnosis of sepsis in premature infants［J］. Pediatr Rep, 2017, 9(3): 7305.
［5］Lima LF，Maschion JM，Rodriguez NA，et al. Procalcitonin for Bacterial Infection Management: A Comprehensive Understanding May Clarify Its Due Value［J］. Pediatr Crit Care Med， 2016， 17(6): 581-582.
［6］邓水香，毛宜虎，曹同瓦，等. 单纯脑外伤患者血清降钙素原的变化规律及其与预后的关系［J］. 中国急救医学， 2015， 35(10): 903-907.
［7］Neumaier M, Braun KF, Sandmann G, et al. C-Reactive Protein in Orthopaedic Surgery［J］. Acta Chir Orthop Traumatol Cech, 2015, 82(5): 327-331.
［8］Rosanova MT, Tramonti N, Taicz M, et al. Assessment of C-reactive protein and procalcitonin levels to predict infection and mortality in burn children［J］. Arch Argent Pediatr, 2015, 113(1): 36-41.
［9］Ansarin K, Rashidi F, Namdar H, et al. Echocardiographic Evaluation of the Relationship Between inflammatory factors (IL6, TNF-α, hs-CRP) and Secondary Pulmonary Hypertension in patients with COPD. A Cross sectional study［J］. Pneumologia, 2015, 64(3): 31-35.
［10］Kanamori Y, Terawaki K, Takayasu H, et al. Interleukin 6 and interleukin 8 play important roles in systemic inflammatory response syndrome of meconium peritonitis［J］. Surg Today, 2012, 42(5): 431-434.
［11］杨洁，丁少川，梁静. C反应蛋白、降钙素原在重型颅脑损伤患者肺部感染早期诊断价值［J］. 中国地方病防治杂志， 2017， 32(4): 457-458.
［12］Naffaa M, Makhoul BF, Tobia A, et al. Procalcitonin and interleukin 6 for predicting blood culture positivity in sepsis［J］. Am J Emerg Med, 2014, 32(5): 448-451.
［13］丁爽，蒋清清，马萍. 血清PCT、CRP和IL-6联合检测对细菌性血流感染早期诊断价值［J］. 实用医学杂志， 2016， 32(18): 3075-3077.
［14］孙静静，王勇强，曹书华，等.血清PCT、CRP和APACHEⅡ评分的动态变化在预测多发伤合并脓毒症患者预后中的价值［J］. 中国急救医学， 2011， 31（11）：983-986.
［15］Hausfater P. Biomarkers and infection in the emergency unit［J］. Med Mal Infect, 2014, 44(4): 139-145. ［16］Lesina M, W?rmann SM, Neuh fer P, et al. Interleukin-6 in inflammatory and malignant diseases of the pancreas［J］. Semin Immunol, 2014, 26(1): 80-87.
［17］陈亮. C反应蛋白和降钙素原对颅脑损伤患者肺部感染的诊断价值［J］. 重庆医学， 2015， 44(30): 4232-4233.
［18］Gao L, Liu X, Zhang D, et al. Early diagnosis of bacterial infection in patients with septicopyemia by laboratory analysis of PCT, CRP and IL-6［J］. Exp Ther Med, 2017, 13(6): 3479-3483.
