3种评分系统在慢性阻塞性肺疾病急性加重期患者预后评估中应用的比较  

Application of three kinds of scoring system for prognostic evaluation of patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：郝倩[1] 王利芳[1] Hao Qian;Wang Lifang(Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸内科,郑州450052

出　　处：《中华现代护理杂志》2020年第10期1315-1319,共5页Chinese Journal of Modern Nursing

摘　　要：目的比较简化英国胸科协会改良肺炎评分(CRB-65)、BAP-65及DECAF评分系统判断COPD急性加重期(AECOPD)患者预后的诊断效能。方法回顾性收集2017年1月—2018年12月于郑州大学第一附属医院呼吸内科住院治疗的181例AECOPD患者的临床资料及CRB-65、BAP-65、DECAF评分指标。根据患者转归情况,将患者分为病情平稳组(患者出院,121例)和病情危重组(患者转入ICU或死亡,60例),比较两组的临床资料和评分工具得分。以患者死亡和入住ICU为观察终点,分别计算CRB-65、BAP-65及DECAF评分系统判断患者预后的灵敏度、特异度及准确率。绘制3种评分的ROC曲线,并计算曲线下面积(AUC),寻找判断预后的最佳切点。结果病情危重组近1年的发作次数、CRB-65评分、DECAF评分及BAP-65评分级别均高于病情平稳组(t值分别为-4.899、-31.748、-34.611、7.227;P<0.001)。CRB-65评分、BAP-65评分及DECAF评分预测患者疾病转归的最佳截断点分别为≥3分、≥Ⅲ级、≥3分,灵敏度分别为70.00%、81.67%、90.00%,特异度分别为61.16%、77.69%、83.47%,准确率分别为64.09%、79.00%、85.63%。DECAF评分、BAP-65评分及CRB-65评分判断AECOPD患者预后的AUC分别为0.811(95%CI:0.845~0.948)、0.774(95%CI:0.707~0.869)及0.669(95%CI:0.595~0.779),DECAF评分判断AECOPD患者预后的AUC高于BAP-65评分和CRB-65评分(Z值分别为3.891、4.799;P值分别为0.026、0.005)。结论CRB-65、BAP-65及DECAF评分对预测AECOPD患者预后均有一定的临床价值,其中DECAF预测效能最高,CRB-65更方便快捷。Objective To compare the prognostic efficacy of CRB-65(Confusion,Uremia,Respiratory,BP,Age 65 Years),BAP-65(BUN,Altered Mental Status,Pulse,and Age 65 years)and DECAF(Extended MRC Dyspnea Score,Eosinopenia,Consolidation,Acidaemia,and Atrial Fibrillation)scoring systems in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Clinical data,CRB-65,BAP-65 and DECAF scoring rubrics of 181 AECOPD patients hospitalized in the Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively collected.According to the outcomes,the patients were divided into stable disease group(patients discharged,n=121)and critically ill group(patients transferred to ICU or died,n=60).The clinical data and scores were compared between the two groups.The sensitivity,specificity and accuracy of CRB-65,BAP-65 and DECAF scoring systems in predicting the prognosis of the patients was calculated with the death and admission into ICU as the observation endpoints.The receiver operating characteristic curves(ROC)of the three scoring systems were drawn,and the area under the curve(AUC)was calculated to identify the best cut-off point in predicting the prognosis.Results The acute exacerbation frequency,CRB-65 score,DECAF score,and BAP-65 score in the past year in the critically ill group were higher than those in the stable disease group(t=-4.899,-31.748,-34.611,7.227;P<0.001).The best cutoff points of CRB-65 score,BAP-65 score and DECAF score for predicting the patients'outcome were≥3,≥Ⅲ,≥3(sensitivity=70.00%,81.67%,90.00%;specificity=61.16%,77.69%,83.47%;accuracy=64.09%,79.00%,85.63%).The AUC of DECAF score,BAP-65 score and CRB-65 score for predicting the prognosis of AECOPD patients was 0.811(95%CI:0.845-0.948),0.774(95%CI:0.707-0.869),and 0.669(95%CI:0.595-0.779),and the AUC of DECAF score for predicting the prognosis of AECOPD patients was higher than those of BAP-65 score and CRB-65 score(Z=3.891,4.799;P=0.026,0.005).Co

关 键 词：肺疾病 慢性阻塞性 急性加重期 临床评分 诊断效能 预后 

分 类 号：R563[医药卫生—呼吸系统]