降钙素原与APACHEⅡ评分对呼吸机相关性肺炎预后的评估价值  

Clinical research on procalcitonin and APACHE Ⅱ in the evaluation of ventilator-associated pneumonia prognosis

作　　者：王昌明[1] 魏卿[2] 

机构地区：[1]彭州市人民医院呼吸内科,四川省611930 [2]彭州市人民医院重症监护室,四川省611930

出　　处：《中华临床医师杂志（电子版）》2015年第20期22-25,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨血清降钙素原（PCT）水平与急性生理学与慢性健康状况评分（APACHEⅡ）对呼吸机相关性肺炎（VAP）患者预后评估的临床意义。方法选取机械通气时间超过48h的53仍VAP患者和167例非VAP患者为研究对象。按VAP患者临床结局将其分为存活组（42例）及死亡纽（11例），采用酶联免疫吸附法（ELiSA）检测各组血清PCT水平同时记录APACHEⅡ评分情况，分别比较PCT水平的差异以及与APACHEⅡ评分的相关性，评价血清PCT及APACHEⅡ评分对VAP患者预后的预测价值。结果VAP组患者血清PCT水平及APACHEⅡ评分明显高于非VAP组患者（P〈0．05），同时VAP组死亡率（20．8％）也显著高于非VAP组（10．8％）（P〈0．05）死亡组PCT水平及APACHEⅡ评分显著高于存活组（P〈0．05）。相关性分析显示，血清PCT水平与APACHEⅡ评分呈正相关（r=0．623，P=0．000）。ROC曲线分析显示，血清PCT曲线下面积（ACU）为0．832（95％CI．0．795~0．914），其最佳工作点为1．84ng／ml，此时判断VAP患者预后不良的敏感性为81．05％及特异性为83．60％；APACHEⅡ评分ACU为0．845（95％C1：0．789~0．921），其最佳工作点为21．5分，此时判断VAP患者预后不良的敏感性为84．63％，特异性为80．17％。结论VAP患者血清PCT水平和APACHEII评分呈现较好的相关性，APACHEII评分越高，血清PCT水平越高，预后也越差，两者联合可作为预测VAP患者病情严重程度及预后的敏感指标，具有较好的临床运用价值。Objective To investigate the value of serum procalcitonin （PCT） level and acute physiology and chronic health evaluation （APACHE Ⅱ） in prognosis estimation of ventilator associated pneumonia （VAP）. Methods 53 patients with VAP and 167 patients with non-VAP who undergone mechanical ventilation over 48 h were enrolled in the study. According to clinical prognosis, these patients with VAP were divided into survival （42 cases） and death groups （11 cases）. Serum levels of PCT were measured by enzyme linked immunosorbent assay （ELISA）, and APACHE Ⅱ score were analyzed. The differences of serum PCT levels were compared and correlation with APACHE Ⅱ score were analyzed, and which the relationship with the prognosis were also assessed. Results The serum PCT levels and APACHE II score on VAP group was significantly higher than non-groups （P〈0.05）; meanwhile, the mortality in VAP group （20.8%） was also significantly higher than non-VAP group （10.8%）. Compared with the survival group, the death group had higher serum PCT levels and APACHE II score （P〈0.05）. The PCT levels and APACHE II score were positive correlated （r=0.623, P=-0.000）. ROC curves analysis results showed that the area under curve of PCT was 0.832 （95% C1： 0.795-0.914）, and optimal operating point （OOP） was 1.84 ng/ml, which had 81.05% sensitivity and 83.60% specificity; ACU of APACHE II was 0.845 （95% CI： 0.789-0.921）, and OOP was 21.5, which had 84.63% sensitivity and 80.17%specificity. Conclusion The serum PCT levels and APACHE II score show a good correlation in VAP group; When APACHE Ⅱ score is higher, the serum PCT levels are higher and the prognosis are worse. A combination of serum PCT levels and APACHE II score can be used as an effective predictor on the severity and prognosis of VAP patients and have better clinical value.

关 键 词：肺炎 呼吸机相关性 降钙素原 急性生理学与慢性健康状况评分 预后 

分 类 号：R563.1[医药卫生—呼吸系统]