125例基层医院老年社区获得性肺炎患者住院期间死亡影响因素分析  

Analysis of hospitalization death influential factors for 125 cases of elderly community acquired pneumonia patients in a basic-level hospital

作　　者：王晓如[1,2] 李善群[1] 

机构地区：[1]复旦大学附属中山医院呼吸科,上海200032 [2]上海市徐汇区大华医院呼吸科,上海200237

出　　处：《复旦学报（医学版）》2015年第6期764-770,775,共8页Fudan University Journal of Medical Sciences

摘　　要：目的评价基层医院老年社区获得性肺炎(community acquired pneumonia,CAP)患者住院期间死亡相关影响因素。方法收集2012年1月至2015年4月间上海市徐汇区大华医院呼吸内科住院治疗的老年CAP患者125例,按出院时生存情况分为死亡组(19例)和生存组(106例)。分析比较两组患者的一般资料(年龄、基础疾病合并情况、体质指数、血红蛋白水平、血清白蛋白水平、T细胞亚组)和肺炎严重度(PSI、CURB-65和APACHEⅡ评分),并进行统计学分析。结果与生存组相比,死亡组年龄较大,体质指数、血红蛋白水平及血清白蛋白水平显著偏低,CD3+T细胞计数、CD4+T细胞计数及CD8+T细胞计数显著减少,肺炎严重度评分(PSI评分、CURB-65评分和APACHEⅡ评分)显著升高,差异均有统计学意义(P<0.05),且与死亡显著相关(P<0.01),基础疾病合并情况及CD4+/CD8+与死亡不相关(P>0.05)。老年CAP患者年龄与血红蛋白水平、血清白蛋白水平呈显著负相关,与PSI评分、CURB-65评分和APACHEⅡ评分显著正相关(P<0.01),与CD3+T细胞计数和CD4+T细胞计数不相关。血红蛋白水平、血清白蛋白水平与PSI评分、CURB-65评分、APACHEⅡ评分显著负相关,血清白蛋白水平与CD3+T细胞计数及CD4+T细胞计数显著正相关(P<0.01),血红蛋白水平与CD3+T细胞计数及CD4+T细胞计数正相关(P<0.05)。CD3+T细胞计数和CD4+T细胞计数与PSI评分及APACHEⅡ评分显著负相关(P<0.01),CD3+T细胞计数与CURB-65评分负相关(P<0.05),CD4+T细胞计数与CURB-65评分不相关(P>0.05)。体质指数与死亡负相关(P<0.05)。结论高龄、营养不良、免疫功能受损、肺炎病情重是老年CAP患者住院死亡的影响因素,应给予高度关注。积极抗感染等对症治疗,努力改善患者营养状况,调节免疫力等措施对降低老年CAP患者住院死亡率至关重要。Objective To evaluate the death influential factors of elderly patients with community acquired pneumonia（CAP）in a basic-level hospital during hospitalization. Methods We collected125 cases of elderly patients with CAP from respiratory ward in Dahua Hospital of Xuhui District of Shanghai during Jan.,2012 to Apr.,2015.They were divided into death group（19 cases）and survival group（106 cases）according to the survival situation on discharge.General data（age,basic diseases mergers,body mass index,hemoglobin,serum albumin levels,T cell subgroup）,pneumonia severity（PSI,CURB-65 and APACHE Ⅱ scores）of the two groups were compared and analyzed by statistical software. Results Compared with survival group,the death group had advanced age,lower level of hemoglobin,serum albumin,CD3＋T cell count,CD4＋T cell count and CD8＋T cell count significantly（P0.05）;Meanwhile,their pneumonia severity score（PSI,CURB-65 and APACHE Ⅱ scores）increased significantly（P0.05）,which significantly associated with death（P0.01）;While basic diseases mergers or CD4＋/CD8＋had no significant correlation with death（P0.05）.Significant negative correlation was found between advanced age and the level of hemoglobin and serum albumin levels.Significant positive correlation was also found between advanced age and PSI score,CURB-65 score and APACHE Ⅱ score（P0.01）.But no significant correlation was found between advanced age and CD3＋T cell count or CD4＋T cell count.Significant negative correlation was found between the level of hemoglobin,serum albumin levels and PSI score,CURB-65 score and APACHE Ⅱ score（P0.01）.Significant positive correlation was also found between serum albumin levels and CD3＋T cell count and CD4＋T cell count（P0.01）.Positive correlation was found between the level of hemoglobin and CD3＋T cell count or CD4＋T cell count（P0.05）.Significant negative correlation was found between CD3＋T cell count or CD4＋T cell count and PSI score or APACHE Ⅱ score（P0.01）

关 键 词：社区获得性肺炎 老年患者 T细胞亚群 PSI评分 CURB-65评分 APACHEⅡ评分 死亡 

分 类 号：R56[医药卫生—呼吸系统]