痰涂片联合CRP、PCT及IL-6水平检测对老年细菌性肺炎的诊断价值研究

Diagnostic value of sputum smear combined with levels of CRP, PCT and IL-6 for bacterial pneumonia in the elderly patients

摘要:

目的 探讨痰涂片联合C反应蛋白（CRP）、降钙素原（PCT）及白细胞介素-6（IL-6）水平检测对老年细菌性肺炎的诊断价值。方法 选取2019年6月—2022年6月四川省第二中医医院100例老年细菌性肺炎患者作为细菌性肺炎组，另取同期60例老年病毒性肺炎患者作为病毒性肺炎组。两组均接受痰涂片及CRP、PCT及IL-6水平检测，对比两组检测结果，绘制受试者工作特征（ROC）曲线分析痰涂片联合CRP、PCT及IL-6水平检测对老年细菌性肺炎的诊断价值。结果 细菌性肺炎组痰涂片阳性率较病毒性肺炎组高（P <0.05）。细菌性肺炎组WBC、CRP、PCT、IL-6较病毒性肺炎组高（P <0.05）。经点二列相关性分析结果显示，WBC、CRP、PCT、IL-6水平与细菌性肺炎呈正相关（r =0.626、0.618、0.676和0.586，均P <0.05）。ROC曲线结果显示：痰涂片诊断细菌性肺炎的敏感性为0.870（95% CI：0.811，0.931）、特异性为0.867（95% CI：0.806，0.922），CRP敏感性为0.800（95% CI：0.789，0.902）、特异性为0.883（95% CI：0.824，0.953），PCT敏感性为0.850（95% CI：0.802，0.925）、特异性为0.917（95% CI：0.889，0.988），IL-6敏感性为0.790（95% CI：0.725，0.865）、特异性为0.767（95% CI：0.712，0.864），四者联合检测的敏感性为0.950（95% CI：0.845，0.978）、特异性为0.769（95% CI：0.713，0.878）。结论 痰涂片、CRP、PCT、IL-6水平可有效鉴别老年细菌性肺炎与病毒性肺炎，联合检测可进一步提高诊断效能，为后续治疗方案的制订提供参考依据。

Abstract:

Objective To investigate the diagnostic value of sputum smear combined with levels of C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) on bacterial pneumonia in the elderly patients.Methods One hundred elderly patients with bacterial pneumonia admitted to our hospital from June 2019 to June 2022 were selected as the bacterial pneumonia group, and another 60 elderly patients with viral pneumonia were included in the viral pneumonia group. Both groups of patients received sputum smear tests and detection of serum levels of CRP, PCT and IL-6. The results of the two groups were compared, and receiver operating characteristic curves (ROCs) were plotted to analyze the diagnostic value of sputum smear combined with levels of CRP, PCT and IL-6 for bacterial pneumonia in the elderly.Results The rate of sputum smear positivity in the bacterial pneumonia group was higher than that in the viral pneumonia group (P < 0.05). The white blood cell (WBC) count and levels of CRP, PCT, and IL-6 were higher in the bacterial pneumonia group than in the viral pneumonia group (P < 0.05). The point-biserial correlation analysis exhibited that WBC count and levels of CRP, PCT, and IL-6 were positively correlated with the occurrence of bacterial pneumonia (r = 0.626, 0.618, 0.676 and 0.586, all P < 0.05). The ROC curve analysis revealed that the sensitivity and specificity of sputum smear in diagnosing bacterial pneumonia were 0.870 (95% CI: 0.811, 0.931) and 0.867 (95% CI: 0.806, 0.922), respectively. Accordingly, the sensitivity and specificity of the level of CRP for diagnosing bacterial pneumonia were 0.800 (95% CI: 0.789, 0.902) and 0.883 (95% CI: 0.824, 0.953), those of the level of PCT were 0.850 (95% CI:0.802, 0.925) and 0.917 (95% CI: 0.889, 0.988), those of the level of IL-6 were 0.790 (95% CI: 0.725, 0.865) and 0.767 (95% CI: 0.712, 0.864), and those of the combined detection of the four indicators were 0.950 (95% CI: 0.845, 0.978) and 0.769 (95% CI: 0.713, 0.878), respectively.Conclusions Sputum smear and levels of CRP, PCT and IL-6 can effectively distinguish bacterial pneumonia from viral pneumonia in the elderly, and the combination of them may further improve the diagnostic efficacy and provide a reference for the development of subsequent treatment regimens.