血液相关指标在社区获得性肺炎预后评估中的价值  

Value of blood-related index in prognosis assessment of community-acquired pneumonia

作　　者：陈勇[1] 陈宇[1] 张娜 常彩芳[1] 张志华[2] CHEN Yong;CHEN Yu;ZHANG Na;CHANG Cai-fang;ZHANG Zhi-hua(The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院感染内科,河北张家口075000 [2]河北北方学院附属第一医院2.呼吸与危重症医学科,河北张家口075000

出　　处：《中华医院感染学杂志》2019年第23期3573-3576,共4页Chinese Journal of Nosocomiology

基　　金：河北省医学科学研究重点基金资助项目(20160036)

摘　　要：目的探讨分析前白蛋白(Prealbumin,PA)、可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)、红细胞沉降率(erythrocyte sedimentation rate,ESR)水平在社区获得性肺炎(Community acquired pneumonia,CAP)预后评估中的价值。方法选择2015年6月-2018年8月河北北方学院附属第一医院收治的CAP患者98例,按照患者入院结局将其分为存活组79例、死亡组19例,分离鉴定患者病原菌分布情况,以入院72 h为观察点,检测患者PA、sICAM-1、ESR水平以及肺炎严重度指数(pneumonia severity index,PSI),比较死亡组和存活组各指标之间的差异。结果98例CAP患者中,分离病原菌56株,其中革兰阴性菌15株占26.70%、革兰阳性菌27株占48.21%、真菌3株占5.36%,支原体11株占19.64%。死亡组患者sICAM-1、ESR以及PAS水平均高于存活组(P<0.05),死亡组患者PA水平低于存活组(P<0.05)。sICAM-1、ESR均与PSI呈正相关关系(P<0.05),PA与PSI呈负相关关系(P<0.05)。采用ROC曲线分析各指标对患者不良预测价值,PA、sICAM-1、ESR以及PSI对患者死亡预测ROC曲线下面积分别为0.818、0.885、0.806、0.834,各指标联合运用与患者不良预测曲线下面积为0.953。结论PA、sICAM-1、ESR对社区获得性肺炎患者临床预后具有着较高预测价值,且三者联合运用其预测价值更高。OBJECTIVE To explore the value of serum prealbumin(PA),soluble intercellular adhesion molecule-1(sICAM-1)and erythrocyte sedimentation rate(ESR)in the prognosis evaluation of community-acquired pneumonia(CAP).METHODS Totally 98 patients with community-acquired pneumonia admitted to the hospital from Jun.2015 to Aug.2018 were divided into the survival group(79 cases)and the death group(19 cases).Pathogens were isolated and identified.PA,sICAM-1,ESR levels and severity index of pneumonia(PSI)were measured 72 hours after admission,and the differences were compared between the death group and the survival group.RESULTS Totally 56 strains of pathogens were isolated from the 98 patients with community-acquired pneumonia,including 15 strains of Gram-negative bacteria(26.70%),27 strains of Gram-positive bacteria(48.21%),3 strains of fungi(5.36%)and 11 strains of Mycoplasma(19.64%).The levels of sICAM-1,ESR and PAS in the death group were significantly higher than those in the survival group(P<0.05),the PA level of the death group was lower than that of the survival group(P<0.05).SICAM-1 and ESR were positively correlated with PSI(P<0.05),while PA was negatively correlated with PSI(P<0.05).The ROC curve was used to analyze the adverse predictive value of each index.The area under the ROC curve of PA,sICAM-1,ESR and PSI was 0.818,0.885,0.806 and 0.834,respectively.The area under the adverse predictive curve of the combined use of PA,sICAM-1,ESR and PSI was 0.953.CONCLUSION PA,sICAM-1 and ESR have high predictive value for the clinical prognosis of patients with community-acquired pneumonia,and their combined use has higher diagnostic value.

关 键 词：前白蛋白 可溶性细胞间黏附分子-1 红细胞沉降率 社区获得性肺炎 预后评估 

分 类 号：R563.1[医药卫生—呼吸系统]