目的：分析血清降钙素原（PCT）水平对老年重症社区获得性肺炎（Community-acquired pneumo-nia，CAP）预后及病情严重程度的预测价值。方法以我院住院的老年重症CAP患者87例为研究对象，收集其临床资料，根据入院后28天生存情况分为死亡组和存活组。并按CURB、PSI评分标准分组，比较不同分组间入院第1天、第4天PCT水平（PCT1、PCT4）及其变化水平（PCT4-1）的差异。分析死亡组与存活组在PCT1、PCT4、PCT4-1、CURB≥3分、PSI≥4级5项因素方面的差异，在其中筛选死亡的独立危险因素。用受试者工作特征曲线（ROC曲线）下面积（AUC）评估各项独立危险因素单独及联合应用预测28天生存情况的效能，并对各项因素的预测效能进行比较。结果死亡组PCT4显著高于存活组。死亡组PCT4-1水平显著高于存活组，死亡组为正值，存活组为负值，即死亡组PCT4较PCT1在升高，而存活组已在下降。PCT1、PCT4水平在CURB≥3组显著高于CURB＜3组。PCT4、PCT4-1、CURB≥3分三项因素为死亡的独立危险因素，其预测死亡的AUC值分别为0.8768、0.7995、0.7054，PCT4、PCT4-1 AUC值无显著差异，但PCT4的AUC值显著高于CURB≥3分，三项因素合并的AUC值为0.853，显著高于CURB≥3分，其预测死亡的敏感度为81.1％，特异度为90.0％。结论动态监测血清PCT水平，对判断老年重症CAP的预后及病情严重程度有一定价值。%Objective To investigate the prognostic value of PCT in elderly patients with severe community-acquired pneumonia (CAP).Methods 87 elderly patients with severe CAP were examined.Their clinical data were collected and they were divided into different groups by CURB,PSI evaluation score and 28-d clinical outcome. The difference of PCT levels was compared within 1 day (PCT1 )and 4 days (PCT4)after admission and the value of PCT4 minus PCT1 (PCT4-1 )was also recorded in different groups.The independent risk factors associated with death were analyzed.Their prediction performance for predicting 28-day survival was compared.Results The levels of PCT4 and PCT4-1 were significantly higher in the death group than in the survival group.The levels of PCT1 and PCT4 were higher in the CURB≥3 group than in the CURB<3 group.PCT4,PCT4-1 and CURB≥3 were independ-ent risk factors associated with death (P<0.05),and its value of AUC for predicting death was 0.8768,0.7995 and 0.7054 respectively.The AUC of PCT4 was significantly larger than that of CURB≥3. The AUC of PCT4,PCT4-1 and CURB≥3 together was 0.853.Its sensitivity of predicting death was 81.1% and its specificity was 90.0%. Conclusion The dynamic monitoring of PCT has value of predicting 28-day survival and helps physicians evaluate the severity of illness accurately in elderly patients with severe CAP.
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