血清YKL-40预测呼吸机相关性肺炎患者28 d病死率的价值  

The value of serum YKL-40 in predicting 28 day mortality of patients with ventilator-associated pneumonia

作　　者：杨庆羚 白小燕[1] 刘诗兰 李文娟 范筱艾 刘波[1] 陈梅 包勇[2] Yang Qingling;Bai Xiaoyan;Liu Shilan;Li Wenjuan;Fan Xiaoai;Liu Bo;Chen Mei;Bao Yong(Department of Respiration, Chengdu Fifth People's Hospital, Sichuan Province, Chengdu 610000,China)

机构地区：[1]成都市第五人民医院呼吸科,610000 [2]成都市第三人民医院呼吸科

出　　处：《疑难病杂志》2020年第4期330-334,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：四川省科学技术计划项目(2014JY0136)。

摘　　要：目的分析血清YKL-40对呼吸机相关性肺炎患者28 d病死率的预测价值。方法收集2018年1月—2019年4月成都市第五人民医院呼吸科诊治呼吸机相关性肺炎患者134例,以28 d生存情况分为死亡组(n=45)和生存组(n=89),入院当天和第7天对患者进行CPIS、APACHEⅡ、SOFA评分,并检测血清CRP、YKL-40含量;ROC曲线分析YKL-40对呼吸机相关性肺炎患者28 d病死率的预测价值。结果死亡组第1天APACHEⅡ、CPIS、SOFA评分,CRP、YKL-40含量高于生存组(t/P=17.167/<0.001、2.006/0.047、7.649/<0.001、13.093/<0.001、15.127/<0.001),第7天APACHEⅡ、CPIS、SOFA评分,CRP、YKL-40含量高于生存组(t/P=17.037/<0.001、3.465/<0.001、18.294/<0.001、8.281/<0.001、15.761/<0.001)。呼吸机相关性肺炎近期死亡与第7天APACHEⅡ评分、SOFA评分、YKL-40呈正相关(P<0.05),与第1天APACHEⅡ评分、SOFA评分、YKL-40、BMI、年龄、CRP、细菌感染比率、CPIS不相关(P>0.05);ROC曲线分析显示,YKL-40的ROC曲线下面积为0.934,OR为1.32,95%CI 0.889~0.979,敏感度0.738,特异度0.813,Youden指数0.551。结论YKL-40蛋白可作为评估呼吸机相关性肺炎患者预后的参考指标,具有一定的临床研究价值。Objective To analyze the predictive value of serum YKL-40 on 28 day mortality of patients with ventilator-associated pneumonia.Methods From January 2018 to April 2019,134 patients with ventilator-associated pneumonia were diagnosed and treated in the respiratory department of Chengdu Fifth People's hospital.They were divided into death group(n=45)and survival group(n=89)based on 28-day survival.On the day of admission and the 7th day,the patients were assessed with CPIS,APACHEⅡand SOFA,and the levels of CRP and YKL-40 in serum were measured.ROC curve was used to analyze the predictive value of YKL-40 on 28 day mortality of patients with ventilator-associated pneumonia.Results On the first day,APACHEⅡ,CPIS,SOFA score and CRP,YKL-40 content in the death group were higher than those in the survival group(t/P=17.167/<0.001、2.006/0.047、7.649/<0.001、13.093/<0.001、15.127/<0.001).On the 7th day,the scores of APACHEⅡ,CPIS and SOFA,CRP and YKL-40 were higher than those of the survival group(t/P=17.037/<0.001、3.465/<0.001、18.294/<0.001、8.281/<0.001、15.761/<0.001).The recent death of ventilator-associated pneumonia was positively correlated with APACHEⅡ,SOFA and YKL-40 on the 7th day(P<0.05).There was no correlation with APACHEⅡscore,SOFA score,YKL-40,BMI,age,CRP,bacterial infection rate and CPIS(P>0.05).ROC curve analysis showed that the area under the ROC curve of YKL-40 was 0.934,OR=1.32,95%CI 0.889-0.979,sensitivity 0.738,specificity 0.813,Youden index 0.551.Conclusion YKL-40 protein can be used as a reference index to evaluate the prognosis of patients with ventilator-associated pneumonia,and has a certain clinical research value.

关 键 词：YKL-40 呼吸机相关性肺炎 28 d病死率 预测价值 

分 类 号：R56[医药卫生—呼吸系统]