C反应蛋白和临床肺部感染评分在老年社区获得性肺炎预后评估中的作用  

The Value of Dynamic Observation on C-reactive Protein and Clinical Pulmonary Infection Score in Evaluation of the Prognosis of Aged Patients with Community Acquired Pneumonia

作　　者：赵静[1] 秦俭[1] 杨淑芳[1] 

机构地区：[1]首都医科大学宣武医院急诊科

出　　处：《首都医科大学学报》2007年第4期450-453,共4页Journal of Capital Medical University

摘　　要：目的探讨C反应蛋白(CRP)及临床肺部感染评分(CPIS)的变化对老年社区获得型肺炎(CAP)患者预后的评估作用。方法对98名老年CAP患者进行回顾性分析,以同期入院的30名老年非感染患者为对照组。分别记录和检测肺炎组入院第1天、第7天的CRP、CPIS评分、血白细胞计数(WBC)、中性粒细胞百分比(N)、白蛋白(ALB)和前白蛋白(PA)。根据预后将患者分为生存组和死亡组,通过ROC曲线选取最佳临界点,分别以治疗后CRP下降率<70%和治疗后CPIS下降值<0.5为分组标准,通过统计学处理分析上述不同组别的预后并进行比较。结果入院时CRP在生存组为(77.87±69.97)mg/L,死亡组为(71.10±71.75)mg/L,与对照组(4.30±3.91)mg/L相比显著增高,差异有统计学意义(P<0.01),CRP和CPIS在生存组与死亡组之间差异无统计学意义。治疗7 d后与入院时相比,生存组的CRP(22.44±22.83)和mg/L和CPIS(2.34±2.15)有明显下降,差异有统计学意义(P<0.01),死亡组CRP(61.28±40.37)mg/L和CPIS(6.04±2.23)差异无统计学意义。2者之间相比,死亡组的CRP和CPIS明显高于生存组(P<0.01)。根据ROC曲线计算曲线下面积(AUC),CRP下降率的AUC为0.750,CPIS下降的AUC为0.755。根据ROC曲线计算出最佳临界点,CRP下降率为70.33%,CPIS下降值为0.5。CRP下降率<70%和CPIS下降值<0.52个指标连用对预测死亡的特异性为82.4%、阳性预测值为58.1%,高于单用其中一项指标。对肺炎组的死亡因素进行回归分析得到:Y^=0.551+0.064CPIS2+0.064CPR2-0.205ALB1,该回归方程的决定系数为0.603。结论动态监测CRP和CPIS对于评价老年CAP预后具有重要的临床指导意义。特别是对于临床表现不典型的老年CRP患者,推荐同时监测这2项指标。Objective To study the changes on C-reactive protein(CRP) and clinical pulmonary infection score(CPIS) in aged patients with community acquired pneumonia(CAP) and the value in evaluation of the prognosis.Methods Ninety-eight elderly CAP cases were analysed retrospectively CRP,CPIS,white blood cell(WBC),neutrophil percentage(N),albumin(ALB) and prealbumin(PA) were measured on the 1st and the 7th days after admission.Data were compared with those of 30 aged patients without infection.CAP patients were divided into fatal group and surviaval group.ROC curve was used to determine the optimal limit value.Cases were divided into two groups by taking the decline of CRP less or more than 70% and CPIS less or more than 0.5 as the landmark.Statistical comparison was carried out on the results.Results On the 1st day after admission,the levels of CRP(77.87±69.97)mg/L in survival group and CRP(71.10±71.75)mg/L in the fatal group were much higher than that in the control group(4.30±3.91)mg/L,(P<0.01).The levels of CRP and CPIS were not significantly different between the fatal group and the survival group.After one-week treatment,compared with 1st day,the levels of CRP(22.44±22.83)mg/L and CPIS(2.34±2.15) declined significantly in the survival group.While the levels of CRP(61.28±40.37)mg/L and CPIS(6.04±2.23) were not significantly different in the fatal group.The levels of CRP and CPIS of the fatal group were much higher than those of the survival group(P<0.01).Through comparing AUC,the CRP decline ratio was better than that of the CPIS in predicting prognosis.According to the ROC curve,the optimal limit value in CRPdecline ratio was 70.33% and in CPIS 0.5 Using the two parameters together,the evaluation of treatment success had a specificity of82.4% and positive predictive value of 58.1%.In the regression analysis of the CAP cases,the regression equation is Y^= 0.551+0.064 CPIS2+0.064CPR2-0.205ALB1,the Coefficient is 0.603.Conclusion Dynamic observation of CRP and CPIS provides an important means in evaluating the prog

关 键 词：C反应蛋白 临床肺部感染评分 社区获得型肺炎 老年 预后 

分 类 号：R563.1[医药卫生—呼吸系统]