老年重症肺炎患者血清hs-CRP水平变化及临床意义  

Changes of serum hs-CRP level in elderly patients with severe pneumonia and its clinical significance

作　　者：孙春荣 黄琳娜[2] 崔晓阳[3] 杨霁 SUN Chunrong;HUANG Linna;CUI Xiaoyang;YANG Ji(Department of Respiration,Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University,Beijing,China,100022;The Respiratory Center of China-Japan Friendship Hospital,Beijing,China,100029;The National Respiratory Disease Clinical Research Center of Respiratory and Critical Care Medicine of China-Japan Friendship Hospital,Beijing,China,100029)

机构地区：[1]清华大学附属北京市垂杨柳医院呼吸科,北京100022 [2]中日友好医院呼吸中心,北京100029 [3]中日友好医院呼吸与危重症医学科国家呼吸疾病临床研究中心,北京100029

出　　处：《分子诊断与治疗杂志》2018年第5期347-351,共5页Journal of Molecular Diagnostics and Therapy

摘　　要：目的探讨老年重症肺炎患者血清hs-CRP水平及其临床价值。方法回顾性分析2016年6月至2017年9月在我院诊治的83例老年重症肺炎患者的临床资料,按照患者预后效果分组,其中57例患者预后较好,纳入A组,26例患者预后不良,治疗无效,纳入B组,记录2组患者的年龄、性别、BMI、基础疾病及急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分,并对患者在第1、4、7天静脉取血,收集血清后采用ELISA实验检测hs-CRP、PCT水平。采用多因素Logistic回归分析研究与患者预后相关的因素。结果 B组患者治疗后第7天血清PCT、hs-CRP及APACHEⅡ评分分别为(5.73±1.13)ng/m L、(6.84±0.45)ng/m L和(34.62±5.27)分,均明显高于A组(P<0.05);A组患者在治疗过程中PCT、hs-CRP及APACHEⅡ评分逐渐下降,B组各项指标水平逐渐升高(P<0.05)。经多因素Logistic回归分析,发现PCT、hs-CRP及APACHEⅡ评分是患者影响预后的因素。通过ROC曲线分析发现hs-CRP评估患者预后的AUC为0.834(0.518～0.916)。PCT、hs-CRP及APACHEⅡ评分3项指标联合检查可以预测的检验效能,AUC为达0.864(0.691～0.946),敏感性和特异性分别为85.8%和86.4%。结论患者治疗第7天后血清hs-CRP水平上升提示可能预后不良,需及时采取针对性的临床治疗减轻体内炎性反应,以改善患者预后。Objective To study the clinical value of serum hs-CRP in elderly patients with the severe respiratory disease.Methods The clinical data of 83 elderly patients with severe pneumonia diagnosed in the Respiratory Center of China-Japan Friendship Hospital from June 2016 to September 2017 were retrospectively analyzed.According to the outcome of the patients,57 of them had better prognosis were classified into Group A,while 26 patients had poor prognosis with treatment failure were classified into Group B.Age,gender,BMI,basic diseases,and acute physiology and chronic health scoring systemⅡ(APACHEⅡ)score of 2 groups of patients were recorded,and on the 1st,4th,and 7th day,blood was taken from the vein of the patients,and serum was collected.The levels of hs-CRP and PCT were detected by ELISA.Multivariate Logistic regression analysis was performed to study the influencing factors of elderly patients with severe respiratory disease.Results The scores of serum PCT,hs-CRP and APACHEⅡin group B were(5.73±1.13)ng/mL,(6.84±0.45)ng/mL and(34.62±5.27)respectively after 7 days of treatment,which were significantly higher than those in the group A(P<0.05).After treatment,the scores of PCT,hs-CRP and APACHEⅡin the group A decreased,but increased in the group B(P<0.05).Multivariate Logistic regression analysis showed that PCT,hs-CRP and APACHE II score were independent risk factors for the poor prognosis for elderly patients.The ROC curve analysis showed that the AUC of hs-CRP in predicting the prognosis of patients was 0.834(0.518-0.916).The 3 indexes of PCT,hs-CRP and APACHEⅡscore can be used to predict the effectiveness of the test.The AUC is 0.864(0.691-0.946),and the sensitivity and specificity are 85.8%and 86.4%,respectively.Conclusion The increase of serum hs-CRP level after the 7th day of treatment suggests that the prognosis may be poor.It is necessary to take timely targeted clinical treatment to reduce the inflammatory response in vivo to improve the prognosis of patients.

关 键 词：重症肺炎 超敏C-反应蛋白 酶联免疫反应 

分 类 号：R563.1[医药卫生—呼吸系统]