中性粒细胞弹性蛋白酶对呼吸机相关性肺炎诊断及转归的评估价值  

Diagnosis and prognosis evaluation value of neutrophil elastase in ventilator-associated pneumonia

作　　者：梁添书 邬敏志[1] 谭家余[1] 吴志雄[1] 杨博[1] 袁春雷[2] 

机构地区：[1]南方医科大学附属中山市博爱医院中心ICU,广东中山528403 [2]南方医科大学附属中山市博爱医院检验科,广东中山528403

出　　处：《中华危重病急救医学》2016年第9期785-789,共5页Chinese Critical Care Medicine

基　　金：广东省自然科学基金（10151401501000001）;广东省中山市科技计划项目（20132A023）

摘　　要：目的探讨中性粒细胞弹性蛋白酶（NE）对呼吸机相关性肺炎（VAP）患者诊断与转归的评估价值。方法回顾性分析2012年9月至2015年10月南方医科大学附属中山市博爱医院中心重症加强治疗病房（ICU）机械通气患者的临床资料，根据患者是否发生VAP分为两组，记录患者上机时、诊断VAP时（非VAP患者取上机〉48h至停机前最差值）和停机前血清及支气管肺泡灌洗液（BALF）中NE水平、炎症指标、临床肺部感染评分（CPIS）、机械通气时间及转归情况。采用受试者工作特征曲线（ROC）分析NE对VAP的诊断和预后评估价值。结果最终VAP组入选38例，非VAP组入选40例，两组患者基线资料均衡。VAP组和非VAP组上机时血清及BALF中NE水平均较低且无明显差异[血清NE（μg／L）：67．04（63．00，75．75）比69．OO（63．75，75．00），BALF中NE（μg／L）：96．26（85．26，176．01）比95．26（86．76，107．11），均P〉0．05]。连续监测结果显示，非VAP组机械通气过程中血清及BALF中NE水平无明显变化，而VAP组诊断VAP时血清及BALF中NE水平较上机时明显升高[μg／L：157．00（153．04，165．75）比67．04（63．00，75．75），178．04（153．00，188．25）比96．26（85．26，176．01），均P〈0．05]，VAP临床治愈后准备停机前血清及BALF中NE水平明显下降[μg/L：75．67（64．51，110．55）比157．00（153．04，165．79），95．50（66．56，183．02）比178．04（153．00，188．25），均P〈0．05]。对VAP组诊断VAP时的NE进行四分位数分组，发现血清及BALF中NE水平越高，CPIS评分越高，机械通气时间越长，预后越差（均P〈0．01）。与非VAP组比较，VAP组白细胞计数（WBC）、中性粒细胞比例、C-反应蛋白（CRP）和降钙素原（PCT）均明显升高（均P〈0．01）。VAP患者BALF中NE水平与WBC、中性粒细胞比例、CRP和PCT均呈显著正相关（r值分别为0．Objective To investigate the diagnosis and prognosis evaluation value of neutrophil elastase （NE） in ventilator-associated pneumonia （VAP）. Methods A retrospective analysis was conducted. The data of patients undergoing mechanical ventilation admitted to Department of Central Intensive Care Unit （ICU） of Boai Hospital of Zhongshan City Affiliated to Southern Medical University from September 2012 to October 2015 were enrolled. The patients were divided into two groups according to whether they suffered from VAP or not. The content of NE in serum and bronchoalveolar lavage fluid （BALF） at the time of mechanical ventilation start, VAP diagnosis （the worst value from 48 hours after mechanical ventilation start to weaning in non-VAP patients）, and at the time before mechanical ventilation weaning, as well as inflammation parameters, clinical pulmonary infection score （CPIS）, duration of mechanical ventilation and prognosis were recorded. Receiver operating characteristic curve （ROC） was used to analyze the predictive value of NE on VAP diagnosis and prognosis. Results Finally 38 patients were enrolled in the VAP group, and 40 in non-VAP group, and baseline data was similar between the two groups. There was no significant difference in the content of NE in serum and BALF between VAP group and non-VAP group [serum NE （p-g/L）： 67.04 （63.00, 75.75） vs. 69.00 （63.75, 75.00）, BALF NE （p-g/L）： 96.26 （85.26, 176.01） vs. 95.26 （86.76, 107.11）, both P 〉 0.05]. From continuous monitoring, no significant change in the content of NE in serum and BALF during mechanical ventilation was found in the non-VAP group, but the content of NE in serum and BALF at the time of VAP diagnosis in VAP group was significantly higher than that at mechanical ventilation start [μg/L： 157.00 （153.04, 165.75） vs. 67.04 （63.00, 75.75）, 178.04 （153.00, 188.25） vs. 96.26 （85.26, 176.01）, both P 〈 0.05], and NE content in serum and BALF was significantly decreased at the time a

关 键 词：呼吸机相关性肺炎 中性粒细胞弹性蛋白酶 支气管肺泡灌洗液 转归 

分 类 号：R563.1[医药卫生—呼吸系统]