“白肺样”表现的社区获得性肺炎临床特征及预后分析  

Clinical features and prognostic factors of community-acquired pneumonia with “the white lung” in the CT scan

作　　者：魏素妮 周颖[1] 卢瑶[1] 叶君如[1] 欧阳金生[1] 陈成水[1] 李玉苹[1] 

机构地区：[1]温州医科大学附属第一医院呼吸与危重症医学科,浙江温州325015 [2]温州市中心医院老年医学科,浙江温州325000

出　　处：《温州医科大学学报》2016年第7期521-525,共5页Journal of Wenzhou Medical University

基　　金：吴阶平基金(2014-94)

摘　　要：目的：了解“白肺样”表现的社区获得性肺炎（CAP）患者的临床特征，分析预后相关指标。方法：回顾性研究自2011年1月至2014年8月间，入住温州医科大学附属第一医院重症监护室，影像学为“白肺样”表现的CAP患者的临床资料，分析预后相关指标。结果：共123例，存活组55例，死亡组68例，其中发热86．2％，呼吸困难89．4％，病死率55．3％。34例检出病原菌，总检出率为27．6％。死亡组和存活组比较：年龄（62．86±14．58vs56．21±13．90）岁，氧合指数（PaO2／FiO2）（191．46±125．25vs240．37±104．55）mmHg，乳酸脱氢酶（LDH）水平（715．40±414．94vs552．68±283．95）U／L，D－二聚体（DD）值（7．02±6．94vs3．60±3．50）mg／L，肺炎严重程度指数（PSI）评分（116．96±37．27vs89．18±45．73）分，CURB-65评分（1．76±0．91vs1．17±1．01）分，2组间比较差异有统计学意义（P〈0．05）。Logistic回归分析显示，PSI评分、LDH及DD是“白肺样”表现的CAP独立预后判断指标。ROC曲线分析可见，PSI评分、DD和LDH三者联合应用的曲线下面积（AUC）值最大，为0．759（95％CI：0．675～0．844），其敏感性为77．1％，特异性为67．9％。PsI＋DD＋LDH联合应用较单个指标有更好的预后判断价值。结论：PSI评分、DD、LDH是独立预后判断的指标，PSI、DD及LDH三者联合应用可提高对“白肺样”表现的CAP的预后判断。Objective： To investigate the clinical features and the prognostic factors of community-acquired pneumonia （CAP） with ＂the white lung＂ in the CT scan. Methods： A retrospective analysis were used. Adult patients with CAP who fulfilled ＂the white lung＂in the CT scan from Jan 2011 to Aug 2014 in the First Affiliated Hospital of Wenzhou Medical University were enrolled and detailed data were recorded, receiver operating characteristic （ROC） curve was obtained. Results： 123 patients were enrolled, 68 cases in the death group and 55 cases were survived. The mortality was 55.3%. Fever and dyspnea were most common symptoms. 34 cases de- tected pathogenic bacteria, the total detection rate of 27.6%. Compared the death group with the survived group： age （62.86±14.58 vs 56.21±13.90） years, PaO2/FiO2 （191.46±125.25 vs 240.37±104.55） mmHg, LDH value （715.40±414.94 vs 552.68±283.95） U/L, D-dimer value （7.02±6.94 vs 3.60±3.50） mg/L PSI scores （116.96±37.27 vs 89.18±45.73） and CURB-65 scores （1.76±0.91 vs 1.17±1.01） were statistically significant （P〈0.05）. Logistic regression indicated that PSI score, the level of DD and LDH are independent valuable factors for predicting prognosis. AUCs of PSI＋DD＋LDH was 0.759, more higher than one factor. The sensitivity of PSI＋DD＋LDH was 77.1%, specificity was 65.9%. Combination of PSI score and DD and LDH improved the prognosis prediction. Conclusion： PSI score, the level of DD and LDH are independent valuable factors for predicting prognosis. Combination of PSI score and DD and LDH improved the prognosis prediction.

关 键 词：社区获得性肺炎 预后 乳酸脱氢酶 D-二聚体 PSI评分 CURB-65评分 

分 类 号：R563.1[医药卫生—呼吸系统]