血清和肽素MMP-9及MEWS评分预测老年重症肺炎患者预后的价值  

Prognostic value of serum copeptin, MMP-9 and MEWS scores in patients with severe pneumonia

作　　者：陈亮[1] 卓越[1] 曾宗鼎[1] 张璐璐 邢崇浩[1] Chen Liang;Zhuo Yue;Zeng Zong-ding;Zhang Lu-lu;Xing Chong-hao(Department of Respiration, the Third People＇s Hospital of Hainan Province, Sanya 572000, Chin)

机构地区：[1]海南省第三人民医院呼吸科,海南三亚572000

出　　处：《中国急救医学》2018年第5期390-394,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨血清和肽素（copeptin）、基质金属蛋白酶-9（MMP-9）及改良早期预警评分（MEWS）对老年重症肺炎（SP）患者病情评估和预后预测的价值.方法 选取我院重症监护室收治的老年SP患者308例进行前瞻性研究,检测患者血清和肽素及MMP-9水平变化,记录MEWS评分结果及患者预后情况.应用受试者工作特征（ROC）曲线分析血清和肽素、MMP-9及MEWS评分对老年SP患者预后评估的价值.结果 死亡组MEWS评分明显高于存活组（7.22±2.78 vs.2.60±1.65,t=8.602,P＜0.05）,且病死率随着MEWS评分的升高而升高.死亡组第1天、第3天及第5天血清和肽素及MMP-9水平均明显高于存活组[和肽素（pmol/L）：67.48±13.60 vs.38.70±10.45,82.92±18.37 vs.34.61±11.50,74.60±15.36 vs.27.18±8.30;MMP-9 （ng/mL）：236.26±43.37 vs.182.74±38.58,311.28±51.42 vs.170.48±35.16,284.20 ±48.36 vs.147.16 ±32.05;均P＜0.05].ROC曲线显示,第3天血清和肽素、MMP-9及MEWS评分预测SP患者死亡的最佳截断值分别为58.42 pmol/L、243.38 ng/mL和5.30分;其敏感度和特异度较好,分别为80.2％和87.8％,72.6％和80.5％,71.0％和84.8％.结论 血清和肽素、MMP-9及MEWS评分与老年SP患者的病情严重程度及预后相关,第3天血清和肽素水平能准确预测患者28 d的病死率.Objective To investigate the value of serum copeptin,matrix metalloproteinase-9 （MMP-9） and modified early warning score （MEWS） in the assessment and the prognosis in elderly patients with severe pneumonia （SP）.Methods Three hundred and eight cases of elderly SP patients in our ICU were prospectively studied.The changes of serum copeptin and MMP-9 levels were recorded,and the MEWS score and the prognosis of patients were recorded.The value of serum copeptin,MMP-9 and MEWS scores on the prognosis of elderly patients with SP were analyzed by using the ROC curve.Results The MEWS score （7.22 ± 2.78 vs.2.60 ± 1.65） in the death group was significantly higher than that in the survival group （t =8.602,P ＜ 0.05）,and the fatality rate increasedwith the increase of the MEWS score.On the first,third and fifth day of the death group,the serum copeptin and MMP-9 levels were significantly higher than those of the survival group [copeptin （pmol/L）：67.48-± 13.60 vs.38.70 ± 10.45,82.92 ± 18.37 vs.34.61 ± 11.50,74.60 ± 15.36 vs.27.18±8.30,MMP-9 （ng/mL）：236.26 ±43.37 vs.182.74 ±38.58,311.28 ±51.42 vs.170.48 ± 35.16,284.20 ± 48.36 vs.147.16 ± 32.05,all P ＜ 0.05].The ROC curve showed that the prediction of copeptin third day,MMP-9 third day and MEWS score of death in patients with SP,the optimal cut-off values were 58.42 pmol/L,243.38 ng/mL and 5.30 points,its sensitivity and specificity were 80.2％ and 87.8％,72.6％ and 80.5％,71.0％ and 84.8％,respectively.Conclusion Serum copeptin,MMP-9 and MEWS scores are correlated with the severity and prognosis of elderly SP patients,and the serum copeptin level on the third day can accurately predict the 28-day mortality of patients.

关 键 词：老年 重症肺炎(SP) 和肽素 基质金属蛋白酶-9(MMP-9) 改良早期预警评分(MEWS) 预后评估 

分 类 号：R563[医药卫生—呼吸系统]