免疫分析仪检测新型炎症标志物联合心肌损伤标志物与CURB-65评分在社区获得性肺炎合并肺栓塞中预测价值  

Predictive value of new inflammatory markers detected by immunoassay analyzer combined with myocardial injury marker and CURB-65 scores in CAP complicated with PE

作　　者：张长洪[1] 冯改霞 曹亮[1] 李琛[1] 刘建华[1] 张志华[1] ZHANG Chang-hong;FENG Gai-xia;CAO Liang(Respiratory and Critical Care Medicine,The First Affiliated Hospital of Medical North University,Zhangjiakou 075000,China)

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

出　　处：《中国医学装备》2023年第5期123-127,共5页China Medical Equipment

基　　金：2021年河北省医学科学研究课题计划(20210267)“呼吸重症监护病房中重症社区获得性肺炎特征及诊治研究”。

摘　　要：目的:探究免疫分析仪检测新型炎症标志物联合心肌损伤标志物与英国胸科协会改良肺炎评分标准(CURB-65)在社区获得性肺炎(CAP)合并肺栓塞(PE)诊断中的预测价值。方法:选取医院呼吸与危重症医学科收治的100例CAP患者,依据是否合并PE将其分为单纯CAP组(60例)和CAP合并PE组(40例),采用ADVIACentaurCP免疫分析仪检测并比较两组患者淋巴细胞、单核细胞、中性粒细胞及血小板(PLT),以及新型炎性标志物血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)及单核细胞与淋巴细胞比值(MLR),心梗检测中肌钙蛋白I(TnI)以及CURB-65统计分析、绘制受试者工作特征(ROC)曲线评估检测指标在诊断肺炎合并PE中的价值。结果:CAP合并PE组患者的外周血中性粒细胞水平均高于CAP组,差异有统计学意义(t=6.806,P<0.05),而淋巴细胞和PLT差异无统计学意义。NLR、D-二聚体、TnI及CURB-65水平均高于CAP组,差异均有统计学意义(Z=1.977,Z=6.403,Z=3.679,Z=2.372;P<0.05),而单核细胞、MLR及PLR差异无统计学意义;外周血NLR、TnI、D-二聚体及CURB-65水平在CAP合并PE诊断中的ROC曲线下面积(AUC)分别为0.617、0.713、0.888和0.642,联合后诊断效能提高至0.913,截断值分别为3.72、0.24 ng/ml、1.42 mg/l和1分。结论:D-二聚体、TnI、NLR及CURB-65对CAP合并PE有较好的预测价值,为无法开展CT肺动脉造影(CTPA)检查的医疗机构提供一些必要的检测手段,但同时临床医生尚需根据实际病情开展相关检查,避免过度检查。Objective:To explore the predictive value of new inflammatory markers,which were detected by ADVIACENTAUR immunoassay analyzer,combined with myocardial injury markers and“Confusion,urea,respiratory rate,blood pressure,age65,(CURB-65)”of modified pneumonia score of British thoracic society in diagnosing community acquired pneumonia(CAP)complicated with pulmonary embolism(PE).Methods:A total of 100 CAP patients who were treated in the department of respiratory and critical care medicine of hospital were retrospectively selected,and they were divided into single CAP group(n=60)and CAP with PE group(n=40)according to whether complicated with PE.ADVIA Centaur CP immunoassay analyzer was adopted to detect and compare the lymphocyte,monocyte,neutrophils and platelet(PLT)between two groups.The ratio of new inflammatory markers(PLT)to lymphocyte(PLR),the ratio of neutrophils to lymphocyte(NLR)and the ratio of monocyte to lymphocyte(MLR)between two groups also were compared.The troponin I(TnI)of myocardial infarction detection and CURB-65 were analyzed as statistic method,and the receiver operating characteristics(ROC)curve was used to assess the value of detection index in diagnosing the pneumonia complicated with PE.Results:The levels of the neutrophils in peripheral blood of CAP with PE group was significantly higher than that of CAP group(t=6.806,P<0.05),while the differences of lymphocyte and PLT between two groups were no significant.The levels of NLR,D-dimer,TnI and the CURB score of CAP with PE group respectively were higher than those of single CAP group(Z=1.977,Z=6.403,Z=3.679,Z=2.372,P<0.05),while the differences of monocyte,MLR and PLR between two groups were no significant.The areas under curve(AUC)of ROC curve of the levels of NLR,TnI,D-dimer and CURB-65 of peripheral blood respectively were 0.617,0.713,0.888 and 0.642 in diagnosing the CAP complicated with PE,and the diagnostic efficiency after combination was enhanced to 0.913,and the cutoff values of them respectively were 3.72,0.24 ng/ml,1.42mg/l and

关 键 词：社区获得性肺炎(CAP) 肺栓塞(PE) 肌钙蛋白I(TnI) 免疫分析仪 

分 类 号：R563.1[医药卫生—呼吸系统]