血浆正五聚蛋白3、血清降钙素原水平对重度脑外伤病人呼吸机相关性肺炎的早期诊断价值  

Value of plasma PTX3 and serum PCT level in early diagnosis of ventilator-associated pneumonia in patients with severe traumatic brain injury

作　　者：王嘉楠 WANG Jianan(Department of Critical Medicine,The First Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院重症医学科,黑龙江哈尔滨150001

出　　处：《安徽医药》2022年第9期1831-1834,I0004,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨血浆正五聚蛋白3(PTX3)水平对重度脑外伤病人呼吸机相关性肺炎的早期诊断价值。方法选取2017年9月至2018年10月在哈尔滨医科大学附属第一医院神经重症监护室,接受呼吸机机械通气治疗的重度脑外伤病人108例,其中将52例发生呼吸机相关性肺炎病人作为观察组,56例未发生呼吸机相关性肺炎病人作为对照组。两组病人于呼吸机辅助通气前和结束辅助通气后48 h内测定血浆PTX3、血清降钙素原水平及监测心率变化,并采用临床肺部感染评分(CPIS)评估病人肺部感染症状。Pearson相关性分析检验病人PTX3、降钙素原、心率水平与CPIS评分关系。采用Cox回归分析探索重度脑外伤病人呼吸机相关性肺炎的影响因素。ROC曲线分析PTX3、降钙素原水平对呼吸机相关性肺炎早期诊断的临床价值。结果在机械通气撤机后,与对照组比较,观察组病人PTX3[(436.45±106.76)μg/L比(312.28±64.81)μg/L]、降钙素原、心率、CPIS水平明显升高(P<0.05)。PTX3、降钙素原、心率水平均与CPIS评分均呈正相关(P<0.05)。PTX3、降钙素原高表达是重度脑外伤病人呼吸机相关性肺炎的独立危险因素(P<0.05)。血浆PTX3水平诊断重度脑外伤病人呼吸机相关性肺炎的曲线下面积(AUC)为0.961,截断值为404.004μg/L,灵敏度和特异度分别为71.2%、88.5%;降钙素原水平诊断时AUC为0.813,截断值为0.764μg/L,灵敏度和特异度分别为88.5%、87.6%;二者联合诊断时AUC为0.992,灵敏度和特异度分别为92.5%、90.7%。结论PTX3、降钙素原异常表达与重度脑外伤病人呼吸机相关性肺炎发生有密切关系,且血浆PTX3单独或与血清降钙素原联合对重度脑外伤病人呼吸机相关性肺炎均有一定诊断价值,可为临床早期诊断提供一定参考。Objective To investigate the early diagnosis value of plasma pentraxin 3(PTX3)level for ventilator-associated pneumonia in patients with severe traumatic brain injury.Methods One hundred and eight patients with severe traumatic brain injury who received ventilator mechanical ventilation in the neurointensive care unit of The First Affiliated Hospital of Harbin Medical University from September 2017 to October 2018 were selected,among them,52 patients with ventilator-associated pneumonia were taken as the observation group and 56 patients without ventilator-associated pneumonia as the control group.The levels of plasma PTX3,serum procalcitonin and heart rate were measured before and 48 hours after ventilation,and the clinical pulmonary infection score(CPIS)was used to evaluate the symptoms of pulmonary infection.Pearson correlation analysis was used to analyze the relationships between PTX3,procalcitonin,heart rate and CPIS score.The Cox method was used to analyze the risk factors of ventilator-associated pneumonia in patients with severe brain trauma.ROC curve was used to analyze the clinical values of PTX3 and procalcitonin in the early diagnosis of ventilator-associated pneumonia.Results Compared with the control group,the levels of PTX3[(436.45±106.76)μg/L vs.(312.28±64.81)μg/L],procalcitonin,heart rate and CPIS in the observation group were significantly higher after removing mechanical ventilation(P<0.05).PTX3,procalcitonin and heart rate were positively correlated with CPIS(P<0.05).High expressions of PTX3 and procalcitonin were independent risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury(P<0.05).The area under curve(AUC)of PTX3 in the diagnosis of ventilator-associated pneumonia in patients with severe traumatic brain injury was 0.961,the cutoff value was 404.004μg/L,and the sensitivity and specificity were 71.2%and 88.5%,respectively;AUC of procalcitonin level was 0.813,cutoff value was 0.764μg/L,and sensitivity and specificity were 88.5%and 87.6%,respe

关 键 词：肺炎 呼吸机相关性 脑损伤 正五聚蛋白3 降钙素 早期诊断 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学]