老年社区获得性肺炎患者D-二聚体水平与肺炎严重程度的相关性分析  

Analysis of correlation between D-dimer levels and pneumonia severity in elderly patients with community-acquired pneumonia

作　　者：马晓蓉[1] 王勇[1] 张振宁[1] 钱进[1] 许亚丽[1] 王亚梅[1] 潘磊[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院老年医学科,北京100038

出　　处：《中华医院感染学杂志》2013年第23期5653-5655,共3页Chinese Journal of Nosocomiology

基　　金：北京市保健科研基金项目(京11-11)

摘　　要：目的探讨老年社区获得性肺炎（CAP）患者血D-二聚体水平及与肺炎严重度指标的相关性，将D-二聚体作为预警指标，通过干预手段降低老年CAP患者的并发症及病死率。方法选择2010年1—12月住院确诊CAP〉60岁的老年患者197例，分别测定血浆D-二聚体及C-反应蛋白（CRP）水平；依据肺炎严重度指数（PSI）将患者分为Ⅱ～Ⅴ组，其中Ⅱ、Ⅲ组为低危组，Ⅳ组为中危组，Ⅴ组为高危组，并将患者分为脓毒症组和非脓毒症组；依据影像学改变将患者分为单叶肺炎组和多叶肺炎组。结果Ⅱ、Ⅲ、Ⅳ3组与Ⅴ组间D-二聚体水平分别为（283．6±111．7）、（508．4±511．7）、（529．6±415．2）、（1014．0±858．7）mg／L，Ⅱ、Ⅲ、Ⅳ3组与Ⅴ组间比较差异有统计学意义（P〈0．05）；低危组、中危组与高危组间D-二聚体水平分别为（438．8±440．7）、（529．6±415．2）、（1014．0±858．7）mg／L，3组间比较差异有统计学意义（P〈0．01）；〉80岁组与60～79岁患者组D-二聚体水平分别为（489．2±484．9）、（529．6±415．2）mg／L，两组比较差异有统计学意义（P〈0．05）；脓毒症组与非脓毒症组间D-二聚体水平分别为（668．6±651．3）、（478．9±486．6）mg／L，两组比较差异有统计学意义（P〈0．05）；单叶肺炎组与多叶肺炎组D-二聚体为（366．6±214．5）、（821．2±429．8）mg／L，两组比较差异有统计学意义（P〈0．05）；D-二聚体与PSI呈正相关（r=0．524，P〈0．01）；有合并症患者D-二聚体与无合并症者D-二聚体水平分别为（676．6±612．9）、（336．4±232．7）mg／L，两组比较差异有统计学意义（P〈0．05），死亡患者D-二聚体为（1013．4±832．6）mg／L，较前两组水平显著增高（P〈0．05）。结论老年CAP患者D-聚体水平升高，随病情程度加重、年龄增加、肺炎面积扩大及存在合并症，D-二�OBJECTIVE To investigate the correlation between the D-dimer levels and pneumonia severity in elderly patients with community-acquired pneumonia. And to reduce the complication and mortality in elderly patients with community-acquired pneumonia by intervention measures using D-dimer as a pre-warning indictor. METHODS A total of 197 elderly CAP patients whose diagnosed age 〉60 in the hospital were selected, and the D-dimer and C-reactive protein levels of them were detected. The Pneumonia Severity Index （PSI） was used to clas-sify patients intoⅡ-ⅤVgroups, of which the Ⅱ , Ⅲ group were the low risk group, Ⅳ group was the intermediate risk group, V group was the high risk group. Patients were divided into sepsis and non-sepsis groups, and also divided into lobar and muhilobar groups according to the imageological changes. RESULTS The levels of D-dimer in Ⅱ, Ⅲ, Ⅳ, Ⅴ groups were （283.6±111.7）, （508.4±511.7）, （529.6±415.2）, （1014. 0±858. 7）mg/L, respectively. There were significant differences between Ⅱ , Ⅲ, Ⅳ and V groups（P〈0.05）. The levels of D-dimer in the three different risk groups were respectively （438.8±440.7）, （529.6±415.2）, （1014.0±858.7） mg/L, and there were significant differences between them （P〈0.01）. The D-dimer levels in patients over 80 and 60-79 years old were respectively （489.2±484.9）, （529.6±415.2）mg/L, and there were significant differences between two groups （P〈0. 05）. The D-dimer levels in sepsis and non sepsis groups were （668. 6±651. 3）, （478.9±486.6）mg/L, and there were significant differences between the two groups （P〈0.05）. And D-dimer levels in lobar and muhilobar groups were respectively （366. 6±214. 5）, （21.2±429.8）mg/L, and there were significant differences between the two groups （P〈0.05）. There were positive correlation between D-dimer levels and PSI （r=0. 524, P〈0.01）. The D-dimer levels in complication group and non-complication group were（676.6 ±612

关 键 词：社区获得性肺炎 老年 D-二聚体 肺炎严重度指数 

分 类 号：R563.1[医药卫生—呼吸系统]