艾滋病合并肺孢子菌肺炎渗出性病变CT定量评分与血清乳酸脱氢酶的相关性分析  

Pneumocystis jiroveci pneumonia in AIDS: the correlation between SLDH and CT quantitive score of exudative lesion

作　　者：谢浩锋[1] 黄翔[1] 郑晓林[1] 钟庆杨[1] 邹玉坚[1] 殷思纯[1] XIE Hao-feng;HUANG Xiang;ZHENG Xiao-lin;ZHONG Qing-yang;ZOU Yu-jian;YIN Si-chun(Dongguan People's Hospital of Guangdong,Guangdong Dongguan 523000,China)

机构地区：[1]广东省东莞市人民医院,广东东莞523000

出　　处：《新发传染病电子杂志》2018年第1期15-20,共6页Electronic Journal of Emerging Infectious Diseases

基　　金：2016年东莞市科技计划立项课题(201610515000932)

摘　　要：目的探讨艾滋病合并肺孢子菌肺炎渗出性病变的CT定量评分与血清乳酸脱氢酶绝对值的相关性,旨在评价CT定量评分在评估该病严重程度及预测其转归等方面的临床应用价值。方法回顾性分析符合该病临床诊断的88例(共142人次)艾滋病合并肺孢子菌肺炎的胸部CT图像,对其渗出性病变进行的范围、密度及两者综合分析的CT定量评分,并结合同步的血清乳酸脱氢酶绝对值,对两者进行统计学相关性分析;同时根据其临床转归,将上述病例分为非呼吸衰竭组(A组)与呼吸衰竭组(B组),对两组内各项CT定量评分及对应血清乳酸脱氢酶等数据进行组间差异性分析,利用受试者工作特征曲线(receiver-operating characteristic curve,ROC)分析,获取其预测阈值。结果艾滋病合并肺孢子菌肺炎渗出性病变范围、密度及综合CT评分与同步血清乳酸脱氢酶均存在显著正相关性(P<0.01),对应相关系数为0.59、0.68及0.79;A与B两组内各项CT定量评分与对应血清乳酸脱氢酶绝对值均存在明显组间差异性,A组内各项数据均低于B组(P<0.05);在上述各项预测患者发生呼吸衰竭的数据中,CT综合定量评分的准确性最高,其约登指数为0.81,曲线下面积为0.95,预测阈值为79.90分。结论艾滋病合并肺孢子菌肺炎渗出性病变CT定量评分能为早期评估病情严重程度及预测其转归提供客观、准确及可靠的量化数据模型,具有重要的临床参考及应用价值。Objective To investigate the correlation between absolute value of serum lactic dehydrogenase(SLDH)and CT quantitative score of exudative lesion of Pneumocystis Jiroveci pneumonia(PJP)complicating AIDS and to evaluate the clinical value of the CT quantitative scoring in severity assessment and the outcome prediction.Methods A total of 88 cases suffering from AIDS complicated by PJP were selected from 142 patients and their chest CT scans were retrospectively analyzed.The CT quantitative scores were obtained based on the extent and density of the exudative lesion.Their correlation with the in-sync absolute value of SLDH was statistically analyzed.Furthermore,the 88 cases were divided into non-respiratory failure group(Group A)and respiratory failure group(Group B)based on their outcome.The beween groups difference analysis was conducted in terms of CT quantitative scores and corresponding SLDH.The threshold value was predicted by ROC analysis.Results Significant positive correlations between the extent,density and CT quantitative scores of the exudative lesion and the in-sync SLDH were shown(P<0.01),with coefficients of 0.59,0.68 and 0.79,respectively;Significant differences were shown in terms of each CT quantitative score and in-sync absolute value of SLDH between Group A and B,with data of Group A being significantly lower than those of Group B(P<0.05);The CT quantitative scores were proved to be the most accurate predictor for respiratory failure,with a Youden index of 0.81,the area under the curve(AUC)of 0.95 and the prediction threshold of 79.9.Conclusion The CT quantitative scores of exudative lesion of PJP complicating AIDS can provide objective,accurate and reliable data for early assessment of severity and the outcome prediction,which has significant value in clinical practice.

关 键 词：艾滋病 耶氏肺孢子菌 肺孢子菌肺炎 CT 乳酸脱氢酶 

分 类 号：R512.91[医药卫生—内科学] R519[医药卫生—临床医学]