肝素结合蛋白联合APACHEⅡ评分在多重耐药菌感染呼吸机相关性肺炎中的诊断价值  

Diagnostic Value of Heparin Binding Protein Combined with APACHEⅡScore in Ventilator-Associated Pneumonia Caused by Multi-drug Resistant Organisms

作　　者：杨欣 陈润奇 王凯[2] YANG Xin;CHEN Runqi;WANG Kai(Medical Intensive Care Unit,Guilin People′s Hospital,Guilin 541002,China;Intensive Care Unit,Zhujiang Hospital of Southern Medical University,Guangzhou 510280,China)

机构地区：[1]桂林市人民医院重症医学科一病区,广西桂林541002 [2]南方医科大学珠江医院重症医学科,广州510280

出　　处：《医学综述》2021年第11期2244-2248,共5页Medical Recapitulate

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20200826)。

摘　　要：目的探讨肝素结合蛋白(HBP)联合急性生理学和慢性健康状况评分系统(APACHE)Ⅱ评分在多重耐药菌(MDRO)感染呼吸机相关性肺炎(VAP)中的诊断价值。方法选取2016年1月至2020年1月在桂林市人民医院住院的64例VAP患者作为研究对象,根据痰培养的药敏试验是否耐药分为普通VAP组(34例)和MDRO感染VAP组(30例);选取同期无VAP的30例需要气管插管或气管切开有创机械通气治疗的患者作为非VAP组。比较三组患者的HBP、降钙素原(PCT)水平和APACHEⅡ评分,绘制受试者工作特征曲线(ROC曲线)判断HBP、PCT、APACHEⅡ评分鉴别诊断MROD引起VAP的价值。结果三组患者的HBP、PCT水平和APACHEⅡ评分比较差异有统计学意义(P<0.01),其中普通VAP组和MDRO感染VAP组的HBP、PCT水平和APACHEⅡ评分高于非VAP组;MDRO感染VAP组的HBP水平低于普通VAP组[(28.19±2.76)μg/L比(33.77±3.55)μg/L],PCT水平和APACHEⅡ评分高于普通VAP组[0.32(0.23,0.43)μg/L比0.25(0.17,0.37)μg/L、(19.70±3.01)分比(16.56±1.08)分](均P<0.05)。ROC曲线分析显示,HBP诊断MROD感染VAP的最佳临界值为30.456μg/L,灵敏度和特异度分别为83.33%和85.29%;APACHEⅡ评分诊断MROD感染VAP的最佳临界值为17.500分,灵敏度和特异度分别为80.00%和88.24%;HBP+APACHEⅡ评分诊断MROD感染VAP的最佳临界值为0.348,灵敏度和特异度分别为93.33%和82.35%。结论HBP联合APACHEⅡ评分对MORD感染VAP具有较高的诊断价值,早期检测HBP并结合APACHEⅡ评分可及时协助诊断,有助于提高MDRO感染VAP早期治疗的有效性。Objective To investigate the diagnostic value of heparin binding protein(HBP)combined with acute physiology and chronic health evaluation scoring system(APACHE)Ⅱin ventilator-associated pneumonia(VAP)infection by multi-drug resistant organisms(MDRO).Methods A total of 64 VAP patients hospitalized in Guilin People′s Hospital from Jan.2016 to Jan.2020 were included.According to the existence of drug resistance manifested by drug sensitive test of sputum culture,they were divided into a normal VAP group(34 cases)and a MDRO infected VAP group(30 cases);30 patients without VAP during the same period who required endotracheal intubation/tracheotomy and invasive mechanical ventilation were included as a non-VAP group.The levels of HBP,procalcitonin(PCT)and APACHEⅡscore were compared among the three groups.Receiver operating characteristic curve(ROC curve)was drawn to determine the value of HBP,PCT and APACHEⅡscores in the differential diagnosis of MDRO-induced VAP.Results There were statistically significant differences in HBP,PCT levels and APACHEⅡscores among the three groups(P<0.01).The levels of HBP,PCT and APACHEⅡscore in the normal VAP group and the MDRO infected group were higher than those in the non-VAP group;the level of HBP in the MDRO infected VAP group was lower than that in the normal VAP group[(28.19±2.76)μg/L vs(33.77±3.55)μg/L],while the level of PCT and APACHEⅡscore were higher than those in normal VAP group[0.32(0.23,0.43)μg/L vs 0.25(0.17,0.37)μg/L,(19.70±3.01)vs(16.56±1.08)](all P<0.05).ROC curve analysis showed that the optimal cut-off value of HBP for the diagnosis of MDRO infected VAP was 30.456μg/L,and the sensitivity and specificity were 83.33%and 85.29%,respectively.The optimal cut-off value of APACHEⅡscore for the diagnosis of MDRO infected VAP was 17.500,and the sensitivity and specificity were 80.00%and 88.24%,respectively.The optimal cut-off value of HBP+APACHEⅡscore for the diagnosis of MDRO infected VAP was 0.348,and the sensitivity and specificity were 93.33%a

关 键 词：呼吸机相关性肺炎 多重耐药菌 肝素结合蛋白 急性生理学和慢性健康状况评分系统Ⅱ 

分 类 号：R563.1[医药卫生—呼吸系统]