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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (03) : 421 -425. doi: 10.3877/cma.j.issn.1674-6902.2024.03.015

论著

妊娠并发社区获得性肺炎临床特征及降钙素原和炎症指数对其诊断意义
何俊1, 易淑华1, 陈婷婷1, 杨玉1, 李红雨1,†(), 谢飞2, 何健2   
  1. 1. 400038　重庆，陆军（第三）军医大学第一附属医院妇产科
    2. 400038　重庆，陆军（第三）军医大学第一附属医院呼吸与危重症医学科
  • 收稿日期:2024-02-18 出版日期:2024-06-25
  • 通信作者: 李红雨
  • 基金资助:
    重庆市科技局项目(CSTB2022TIAD-KPX0173)

Clinical features and diagnostic value of procalcitonin and systemic immunoinflammatory index in pregnancy complicated with community-acquired pneumonia

Jun He1, Shuhua Yi1, Tingting Chen1, Yu Yang1, Hongyu Li1,†(), Fei Xie2, Jian He2   

  1. 1. Department of Obstetrics and Gynecology, the First Affiliated Hospital of Army Medical University, Chongqing 400038, China
    2. Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Army Medical University, Chongqing 400038, China
  • Received:2024-02-18 Published:2024-06-25
  • Corresponding author: Hongyu Li
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何俊, 易淑华, 陈婷婷, 杨玉, 李红雨, 谢飞, 何健. 妊娠并发社区获得性肺炎临床特征及降钙素原和炎症指数对其诊断意义[J]. 中华肺部疾病杂志(电子版), 2024, 17(03): 421-425.

Jun He, Shuhua Yi, Tingting Chen, Yu Yang, Hongyu Li, Fei Xie, Jian He. Clinical features and diagnostic value of procalcitonin and systemic immunoinflammatory index in pregnancy complicated with community-acquired pneumonia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(03): 421-425.

目的

分析妊娠并发社区获得性肺炎(community-acquired pneumonia, CAP)临床特征及降钙素原和炎症指数对其诊断意义。

方法

选择2020年1月1日至2022年12月31日我院收治的妊娠者11 247例，其中并发社区获得性肺炎102例为观察组，分析临床特征；选择2022年6月1日至2022年12月31日我院收治的健康妊娠者112例为对照组，采用受试者工作特征曲线下面积(AUC)评价降钙素原(procalcitonin, PCT)和炎症指数(inflammation index, Ⅱ)对妊娠并发社区获得性肺炎的诊断。

结果

11 247例中并发社区获得性肺炎102例(0.91%)，平均年龄(30.61±5.31)岁，平均孕周(33.60±5.70)周，中孕晚期(28周及以上)91例(89.22%)，早产8例(7.84%)，低体重儿1例(0.98%)；观察组剖宫产81例(79.41%)高于对照组55例(49.11%)(P<0.001)；两组年龄、BMI比较差异无统计学意义(P>0.05)，观察组体温、白细胞、中性粒细胞、血小板、C反应蛋白、降钙素原和炎症指数高于对照组(P<0.05)。AUC分别为体温95%CI：0.652(0.382～0.922)、白细胞95%CI：0.692(0.612～0.772)、中性粒细胞95%CI：0.672(0.623～0.721)、血小板95%CI：0.601(0.515～0.687)、C反应蛋白95%CI：0.653(0.596～0.710)、降钙素原95%CI：0.925(0.878～0.972)和炎症指数95%CI：0.845(0.784～0.906)，降钙素原和炎症指数有预测价值。

结论

降钙素原和炎症指数对妊娠并发社区获得性肺炎具有预测意义。

关键词: 妊娠, 社区获得性肺炎, 降钙素原, 炎症指数, 临床特征
Objective

To analyze the clinical features and the diagnostic value of procalcitonin(PCT) and systemic immune-inflammation index(Ⅱ) in pregnancy complicated with community-acquired pneumonia(CAP).

Methods

From January 1, 2020 to December 31, 2022, pregnant patients admitted to our hospital were the source of the study, including 102 patients with CAP as the observation group, and A total of 112 healthy pregnant women who were hospitalized and gave birth from June 1, 2022 to December 31, 2022 were selected as the control group. The area under the subject working characteristic curve (AUC) was used to evaluate diagnostic value of procalcitonin (PCT) and inflammation index(Ⅱ) for community-acquired pneumonia in pregnancy.

Results

Among 11247 cases, 102 cases (0.91%) were combined with community-acquired pneumonia, the mean age was (30.61±5.31) years, the mean gestational age was (33.60±5.70) weeks, 91 cases (89.22%) in the third trimester (28 weeks and above), 8 cases (7.84%) in preterm labor, and 1 case (0.98%) in low-weight infant. There were 81 cases of cesarean section in observation group (79.41%) and 55 cases in control group (49.11%) (P<0.001). There was no significant difference in age and BMI between the two groups (P>0.05). The body temperature, white blood cells, neutrophils, platelets, C-reactive protein, procalcitonin and inflammatory index in the observation group were higher than those in the control group (P<0.05). The AUC was 95%CI: 0.652(0.382-0.922) for body temperature, 95%CI: 0.692(0.612-0.772) for leukocytes, 95%CI: 0.672(0.623-0.721) for neutrophils and 95%CI for platelets, respectively: 0.601 (0.515-0.687), C-reactive protein 95%CI: 0.653(0.596-0.710), procalcitonin 95%CI: 0.925(0.878-0.972) and inflammatory index 95%CI: 0.845(0.784-0.906), The predictive value of procalcitonin and inflammatory index was high.

Conclusion

Procalcitonin and systemic immune-inflammation index have good predictive value in pregnancy complicated with CAP.

Key words: Pregnancy, Community-acquired pneumonia, Procalcitonin, Inflammatory index, Clinical features
表1 两组妊娠患者临床资料比较(±s)
临床资料 观察组(n＝102) 对照组(n＝112) 检验值 P值
年龄(岁) 30.62±5.39 30.79±5.06 0.601 0.805
BMI(kg/m2) 27.70±3.95 27.35±3.03 0.556 0.457
孕周(周) 34.88±5.11 38.62±1.57 53.126 0.000
体温(℃) 36.91±0.68 36.21±0.45 8.953 0.000
白细胞(109/L) 10.49±4.76 7.16±2.21 6.659 0.000
红细胞(1012/L) 3.98±1.57 3.76±0.68 1.351 0.178
中性粒细胞(109/L) 9.67±11.88 5.29±3.19 3.757 0.002
血小板(109/L) 182.98±75.54 162.27±41.25 2.519 0.013
淋巴细胞(109/L) 0.62(0.45～0.91) 0.71(0.62～1.53) 0.094 0.189
炎症指数 2 698.76±2 740.75 1 043.26±521.75 6.270 0.000
C反应蛋白(mg/L) 22.09±41.29 6.25±5.17 24.607 0.000
降钙素原(ng/ml) 0.54±1.62 0.08±0.12 2.997 0.003
表2 不同指标对妊娠并发社区获得性肺炎的预测
变　量 曲线下面积(95%CI) 标准误 P值 最佳诊断界值 敏感性 特异性
体温 0.652(0.382～0.922) 0.138 0.001 34.250 0.824 0.563
白细胞 0.692(0.612～0.772) 0.041 0.000 8.070 0.617 0.651
中性粒细胞 0.672(0.623～0.721) 0.025 0.012 7.480 0.492 0.749
血小板 0.601(0.515～0.687) 0.044 0.043 182.180 0.612 0.761
C反应蛋白 0.653(0.596～0.710) 0.029 0.021 8.360 0.520 0.755
降钙素原 0.925(0.878～0.972) 0.024 0.000 0.051 0.905 0.978
炎症指数 0.845(0.784～0.906) 0.031 0.000 1341.180 0.789 0.821
1
Georgescu T. The role of maternal hormones in regulating autonomic functions during pregnancy[J]. J Neuroendocrinol, 2023, 35(12): e13348.
2
Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection[J]. N Engl J Med, 2014, 370(23): 2211-2218.
3
Kodogo V, Azibani F, Sliwa K. Role of pregnancy hormones and hormonal interaction on the maternal cardiovascular system: a literature review[J]. Clin Res Cardiol, 2019, 108(8): 831-846.
4
Maudhoo A, Khalil A. Viral pulmonary infection in pregnancy-Including COVID-19, SARS, influenza A, and varicella[J]. Best Pract Res Clin Obstet Gynaecol, 2022, 85(Pt A): 17-25.
5
应海琼，徐道芬，单晓雪，等. 晚期妊娠宫内感染对母婴的影响[J]. 中华医院感染学杂志，2019, (4): 614-616, 620.
6
杜雪冰，钱　芳，王毅娟，等. 血清IL-6、PCT、TNF-α与GBS感染孕妇不良妊娠结局的关系[J]. 分子诊断与治疗杂志，2024, (1): 23-26, 31.
7
Pan F, Ye T, Sun P, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19)[J]. Radiology, 2020, 295(3): 715-721.
8
Velissaris D, Zareifopoulos N, Lagadinou M, et al. Procalcitonin and sepsis in the Emergency Department: an update[J]. Eur Rev Med Pharmacol Sci, 2021, 25(1): 466-479.
9
Kocaaslan R, Dilli D, Çitli R. Diagnostic value of the systemic immune-inflammation index in newborns with urinary tract infection[J]. Am J Perinatol, 2022, doi: 10.1055/s-0042-1757353
10
中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志，2016, 39(4): 253-276.
11
Tang P, Wang J, Song Y. Characteristics and pregnancy outcomes of patients with severe pneumonia complicating pregnancy: a retrospective study of 12 cases and a literature review[J]. BMC Pregnancy Childbirth, 2018, 18(1): 434.
12
Chen YH, Keller J, Wang IT, et al. Pneumonia and pregnancy outcomes: a nationwide population-based study[J]. Am J Obstet Gynecol, 2012, 207(4): doi: 10.1016/j.ajog.2012.08.023.
13
Sensakovic WF, Royall I, Hough M, et al. Fetal dosimetry at CT: a primer[J]. Radiographics, 2020, 40(4): 1061-1070.
14
Graves CR. Pneumonia in pregnancy[J]. Clin Obstet Gynecol, 2010, 53(2): 329-336.
15
Ashby T, Staiano P, Najjar N, et al. Bacterial pneumonia infection in pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2022, 85(Pt A): 26-33.
16
Bar-Oz B, Bulkowstein M, Benyamini L, et al. Use of antibiotic and analgesic drugsduring lactation[J]. Drug Saf, 2003, 26(13): 925e351.
17
贺艳军，麦彩园，陈陆静，等. 妊娠合并重症社区获得性肺炎孕妇的临床特征及危险因素分析[J]. 中华妇产科杂志，2018, 53(12): 842-848.
18
Lao TT. Pulmonary disorders in pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2022, 85(Pt A): 1-2.
19
Bridwell RE, Carius BM, Long B, et al. Sepsis in pregnancy: Recognition and resuscitation[J]. West J Emerg Med, 2019, 20(5): 822-832.
20
Mor G, Cardenas I. The immune system in pregnancy: a unique complexity[J]. Am J Reprod Immunol, 2010, 63(6): 425-433.
21
Kazma JM, van den Anker J, Allegaert K, et al. Anatomical and physiological alterations of pregnancy[J]. J Pharmacokinet Pharmacodyn, 2020, 47(4): 271-285.
22
Wirz Y, Meier MA, Bouadma L, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials[J]. Crit Care, 2018, 22(1): 191.
23
Maves RC, Enwezor CH. Uses of procalcitonin as a biomarker in critical care medicine[J]. Infect Dis Clin North Am, 2022, 36(4): 897-909.
24
Siriwardena AK, Jegatheeswaran S, Mason JM, et al. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2022, 7(10): 913-921.
25
Branche A, Neeser O, Mueller B, et al. Procalcitonin to guide antibiotic decision making[J]. Current opinion in infectious diseases, 2019, 32(2): 130-135.
26
Lhopitallier L, Kronenberg A, Meuwly JY, et al. Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: pragmatic cluster randomised trial[J]. Bmj, 2021, 374: doi: 10.1136/bmj.n2132
27
Womack J, Kropa J. Community-acquired pneumonia in adults: Rapid evidence review[J]. Am Fam Physician, 2022, 105(6): 625-630.
28
Wang RH, Wen WX, Jiang ZP, et al. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage[J]. Front Immunol, 2023, 14: doi: 10.3389/fimmu.2023.1115031
29
Jiang R, Li P, Shen W, et al. The predictive value of the preoperative systemic immune-inflammation index in the occurrence of postoperative pneumonia in non-small cell lung cancer: A retrospective study based on 1486 cases[J]. Thorac Cancer, 2023, 14(1): 30-35.
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