| BacKgroundThe lungs are the most abundant human vascular organ, it is the body’s only organ of gas exchange, due to the anatomical and other causes of lung sepsis-induced multiple organ failure in the earlier organ damage, clinical manifestations of acute lung injury or acute respiratory distress syndrome. Once patients with acute respiratory distress syndrome will need to enter the respiratory intensive care unit for treatment. Epidemiological survey found that 54% of patients with acute lung injury may be development of acute respiratory distress syndrome within 24 hours, and the emergence of patients with acute respiratory distress syndrome,28-day mortality as high as 25% to 30%, so, if not actively conduct timely and effective treatment, can be gradually developed into multiple organ failure, the prognosis is poor. The study found that as early in disease progression for effective treatment, most patients can be blocked by ALI /ARDS development process, thus suffering from mechanical ventilation and ICU stay. Therefore, early detection of potential deterioration of ordinary pneumonia, and to assess whether reasonable and effective treatment options, whether great benefit to the patient is very important. Only through this approach, in order to alleviate the suffering and economic burden of patients patients.At present, although physicians learn at home and abroad have developed a variety of ways a variety of severe pneumonia diagnostic criteria and treatment guidelines, but they operate in complex clinical use is limited, especially at the grassroots level is not easy to implement hospital. So look for some meaning fast, universal predictor is very important. Wide variety of diagnostic indicators of inflammation, leading clinicians can not effectively select features indicators for diagnosis and assessment of disease, resulting in mild community-acquired pneumonia patients who use combined with antibiotics, resulting in bacterial resistance; or on the trend of severe pneumonia patient vigilance is not enough, do not use a sufficient amount of antibiotics effective against infection, resulting in disease worsening, or even septic shock cases, death. Therefore, selecting appropriate indicators evaluate and provide guidance on the treatment of patients with diseases of great significance.C-reactive protein is produced by the liver cells when a non-specific acute phase protein, the universal participation of various inflammatory response in vivo. Under normal circumstances in healthy patients with low levels of serum. C-reactive protein under distress on a variety of body, such as various infections (including various body organs), an organ and tissue damage and necrosis can rise rapidly, and its levels of less susceptible to antibiotics, anemia, immunosuppressants, Effect of glucocorticoid, and with effective control of the primary disease and illness recovery, C-reactive protein levels gradually decreased to the normal range. So often as a reflection of the degree of infection as well as evaluating the effectiveness of treatment sensitive indicators. Traditional detection methods C- reactive protein is lagging behind, already there is a high false positive and false negative diagnosis and treatment of serious disturbance of the disease, with the development of detection technology, currently used enzyme-linked immunosorbent assay, latex-enhanced immune scatter or transmission can be fast and reliable determination of C- reactive protein levels of turbidity technology, namely high-sensitivity C-reactive protein.Procalcitonin is one precursor of the calcitonin, procalcitonin has a great advantage in the early identification of bacterial infections and non-bacterial infection. When bacterial infections, especially when their levels of severe infection in the blood not only significantly increased, while the evaluation of the severity of infection and know prognosis and outcome of the disease is important.Procalcitonin generally not factors in hormone levels, clinical medicine and so on, good stability. A large number of scholars through experiments and studies show that procalcitonin in patients with bacterial infection test results will rise, especially in the performance of the whole body will be more severe bacterial infections or sepsis significantly increased in serum and in foreign countries even in the medical field it is considered to be a sensitive indicator of diagnosis of severe sepsis, and widely used in clinical diagnosis, treatment and prognosis observation.D-dimer is a specific fibrin monomer product first by activating factor XIII after crosslinking, and then by hydrolysis to produce plasmin, is a specific marker of the energy tips fibrinolytic process. Bacteria, viruses, toxins and other harmful substances into the blood once, can directly activate Ⅻ factor, the enable extrinsic coagulation pathway; endogenous coagulation system activation has in turn activates anticoagulant system, namely fibrinolytic system, allowing D- dimer increased. Severe pneumonia often accompanied by systemic inflammatory response, and may induce activation of the coagulation system, the fibrinolytic system will further lead to hyperthyroidism, resulting in elevated D- dimer. The study found D- dimer as a product of the coagulation /fibrinolytic system activation, which significantly increased levels of inflammatory diseases when, and with the aggravation of inflammation increases, can be valued as an observer severe pneumonia severity index.ObjectiveThe study found that procalcitonin, high-sensitivity C-reactive protein and D-dimer in the blood levels of inflammation is significantly increased, but on the above indicators of severe pneumonia diagnosis and prognosis of research is also less. This paper by detecting ordinary pneumonia and severe pneumonia patients blood procalcitonin level sensitivity C-reactive protein and D- dimer, research procalcitonin, high-sensitivity C-reactive protein and D-dimer Severe early judgment and prognosis of pneumonia in value.MethodsA retrospective analysis of March 2014 to March 2015 during their stay. Patients with community-acquired pneumonia among 53 people,56 patients with severe pneumonia, severe pneumonia in patients with sepsis group of 32 people divided into groups of 24 people with severe sepsis, to 46 healthy volunteers as control group. The study inclusion criteria, patients with common reference pneumonia Respiratory Diseases Branch of the Chinese Medical Association in 2006 to develop "community-acquired pneumonia diagnosis and treatment guidelines" in the clinical diagnosis is based, should be excluded among tuberculosis, lung cancer, non-infectious pulmonary interstitial diseases (connective tissue disease, pneumoconiosis, etc.), pulmonary edema, pulmonary eosinophil infiltration syndrome and pulmonary vascular inflammation, atelectasis, pulmonary embolism can be established after clinical diagnosis of community-acquired pneumonia. Severe pneumonia inclusion criterion-referenced 2007 Infectious Diseases Society/American Thoracic Society published on diagnostic criteria of severe pneumonia, while excluding exclude malignant solid tumors, severe liver and kidney failure, poisoning, diabetic ketoacidosis and congenital metabolic diseases, active pulmonary tuberculosis, pulmonary tuberculosis associated with old cavity, pulmonary infarction, autoimmune disease caused by lung disease, lung infection after organ transplantation, known as blood or clotting dysfunction, thromboembolic disease (pulmonary embolism), long-term use of warfarin or low molecular weight heparin and pregnant women and so on. Basic and blood procalcitonin compare patient admission, high-sensitivity C-reactive protein levels and D- dimer. On the basis of adequate treatment, the detection of patients 24 hours,48 hours,72 hours blood procalcitonin, High-sensitivity C-reactive protein levels and D-dimer when and discharged more than index in each study group of patients The process of change. The study of death in patients hospitalized for 24 hours, 48 hours and rescue the blood original, high-sensitivity C-reactive protein and D-dimer levels of calcitonin. By comparison each time procalcitonin in patients with changes in High-sensitivity C-reactive protein and D-dimer levels compared whether the differences were statistically significant.Results1. The difference of age and sex between ordinary pneumonia, severe pneumonia and control group have no statistically significant, but the Differences of leukocyte count and neutrophil percentage between ordinary pneumonia group and severe pneumonia have statistically significant. In ordinary pneumonia group and severe pneumonia, the blood leukocyte count, neutrophil percentage, procalcitonin, high-sensitivity C-reactive protein and D- dimer increased compared with the control group, the difference were statistically significant (All P<0.05). The differences of leukocyte count, neutrophil percentage, procalcitonin, high-sensitivity C-reactive protein and D-dimer in severe pneumonia group increased compared with ordinary pneumonia group were statistically significant (P<0.05).2. The procalcitonin levels of severe sepsis patients increased compared with patients with sepsis, the difference was statistically significant (P<0.05). With effective treatment, the procalcitonin levels have decreased, the procalcitonin levels decreased at the treatment of 48h,72h after admission, and the difference were statistically significant (All P<0.05). But the procalcitonin levels slightly lower in the severe sepsis patients and sepsis when compared with admission in the treatment of 24h, the difference were no statistically significant (P> 0.05).The procalcitonin levels in sepsis group and severe sepsis patients had no difference between the procalcitonin levels at discharge (All P> 0.05).3.The High-sensitivity C-reactive protein levels of severe sepsis increased at admission than sepsis, the difference was statistically significant (P<0.05). After treatment 24h, 48h,72h the high-sensitivity C-reactive protein levels decreased compared with admission the difference were statistically significant (All P<0.05). The High-sensitivity C-reactive protein levels of sepsis group and severe sepsis patients had no significant difference when at discharge (All P> 0.05).4. The D- dimer levels of severe sepsis patients at admission were increased than patients with sepsis, the difference were statistically significant (P<0.05).After 24h effective treatment,the D- dimer levels increased compared with admission, the difference had no statistically significant (All P> 0.05). After 48h and 72h effective treatment, the D- dimer levels in the sepsis patients and severe sepsis group lower than those on admission, the difference were statistically significant (All P<0.05). The differences D- dimer levels between was not statistically significant (P> 0.05) in sepsis group and severe sepsis patients discharged.5. The levels of procalcitonin, high-sensitivity C-reactive protein and D-dimer in died patients after treatment 24h,48h, and the rescue were progressively increased, the difference were statistically significant (All P<0.05).Conclusion1. The levels of high-sensitivity C-reactive protein and D-dimer increased in pneumonia, and with the pneumonia severity increases.2. The procalcitonin have no obvious advantages in the identification of common aspects of pneumonia compare with high-sensitivity C-reactive protein and D-dimer, but it is important in the diagnosis of severe pneumonia and to assess the severity of diseases.3. With the effective treatment,the levels of procalcitonin, high-sensitivity C-reactive protein and D- dimer decreased, while the death of the patients continued to rise.4. Joint detection the procalcitonin, high-sensitivity C-reactive protein and D-dimer are important for early diagnosis and prognosis of severe pneumonia. |
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