中性粒细胞弹性蛋白酶对诊断呼吸机相关肺部感染及判断预后的价值  

Effect of neutrophil elastase on diagnosis and clinical outcome of ventilator associated pulmonary infection

作　　者：冼丽娜 杨远征[1] 胡志华[1] Li-na Xian;Yuan-zheng Yang;Zhi-hua Hu(Department of Intensive Medicine,The First Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570102,China)

机构地区：[1]海南医学院第一附属医院重症医学科,海南海口570102

出　　处：《中国现代医学杂志》2018年第30期100-104,共5页China Journal of Modern Medicine

摘　　要：目的探索中性粒细胞弹性蛋白酶(NE)对呼吸机相关肺部感染(VAP)患者诊断与临床结局的影响。方法回顾性分析2012年1月-2017年1月该院ICU收治的并进行机械通气的228例患者病例资料、并根据患者是否发生VAP将患者分为VAP组(n=86)和非VAP组(n=142)。观察两组一般资料,机械通气前、诊断VAP时、撤机时的血清NE及支气管肺泡灌洗液(BALF)中NE浓度;血清NE和BALF中NE浓度与机械通气时间、临床肺部感染评分(CPIS)、氧合指数、死亡率的关系;NE在诊断VAP中的价值。结果两组不同时间点的血清NE浓度与BALF中NE浓度有差异(F=13.495和21.832,均P=0.000);两组间血清NE浓度和BALF中NE浓度有差异(F=25.426和19.426,均P=0.000),VAP组不同时间点的血清NE浓度与BALF中NE浓度均高于非VAP组(P<0.05);两组血清NE浓度与BALF中NE浓度变化趋势有差异(F=14.372和9.387,P=0.000);血清NE浓度与机械通气时间、CPIS评分、死亡率呈正相关(r_s=0.753、0.475及0.801,P=0.000、0.002及0.000);与氧合指数呈负相关(r_s=-0.717,P=0.000);BALF中NE浓度与机械通气时间、CPIS评分、死亡率呈正相关(r_s=0.731、0.528及0.680,P=0.000、0.001及0.000);与氧合指数呈负相关(r_s=-0.729,P=0.000);以血清NE>150μg/L为阳性指标诊断VAP的敏感性为83.72%,特异性为94.37%,以BALF中NE>170μg/L为阳性指标诊断VAP的敏感性为87.21%,特异性为96.48%。结论NE在早期诊断VAP中具有较高的敏感性和特异性,机械通气患者血清和BALF中NE浓度越高,患者VAP越严重,预后越差。Objection To explore the effect of neutrophil elastase （NE） on the diagnosis and clinical outcome of ventilator associated pulmonary infection （VAP）. Methods The clinical data of 228 patients undergoing mechanical ventilation in the ICU of our hospital from January 2012 to January 2017 were retrospectively analyzed. The patients were divided into VAP group （n = 86） and non VAP group （n = 142）. General data of the two groups, concentration of NE in serum and BALF at different time points, relationship between the concentration of NE in serum and BALF and mechanical ventilation time, CPIS, oxygenation index, mortality and the value of NE in diagnosis of VAP were observed. Results At different time points, there was difference in concentration of NE in serum and BALF among patients （F = 13.495 and 21.832, all P = 0.000）. There was difference in concentration of NE in serum and BALF at different time points between VAP group and non VAP group （F = 25.426 and 19.426, all P = 0.000）; the concentration of NE in serum and BALF of the VAP group were higher than that of the non VAP group at differenttime points （P 〈 0.05）. There was difference in variation tendency of NE in serum and BALF between VAP group and non VAP group （F = 14.372 and 9.387, all P = 0.000）; the concentration of NE in serum was positively correlated with the duration of mechanical ventilation, CPIS and mortality （rs = 0.753, 0.475 and 0.801, P = 0.000, 0.002 and 0.000）, while was negatively correlated with oxygenation index （rs = -0.717, P = 0.000）. The concentration of NE in BALF was positively correlated with the duration of mechanical ventilation, CPIS and mortality （rs = 0.731,0.528 and 0.680, P = 0.000, 0.001 and 0.000）, while was negatively correlated with oxygenation index （rs = -0.729,P = 0.000）. Taking serum NE 〉 150 μg/L as a positive index, the sensitivity was 83.72% and specificity was 94.37%in diagnosing VAP; taking BALF NE 〉 170 μg/L as a positive index, the sensitivity was 87.21% a

关 键 词：中性粒细胞弹性蛋白酶 呼吸机相关性肺部感染 诊断 预后 

分 类 号：R563.19[医药卫生—呼吸系统]