社区获得性肺炎合并肺炎旁胸腔积液的临床分析  

Clinical analysis of community-acquired pneumonia with parapneumonic pleural effusion

作　　者：钟晨阳 陈成[1] ZHONG Chenyang;CHEN Cheng(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院呼吸与危重症医学科,江苏苏州215006

出　　处：《临床肺科杂志》2023年第7期984-988,共5页Journal of Clinical Pulmonary Medicine

基　　金：江苏省“六大人才高峰”培养对象(WSN-101)。

摘　　要：目的比较伴和不伴肺炎旁胸腔积液的社区获得性肺炎(community acquired pneumonia,CAP)患者的基础疾病因素、实验室检查、影像学资料、疾病严重程度,分析影响CAP合并肺炎旁胸腔积液患者的临床因素。方法回顾性分析2018年1月1日至2022年3月31日期间苏州大学附属第一医院呼吸与危重症医学科CAP患者临床数据,将患者分成合并胸腔积液组(CAP-PE组)和不合并胸腔积液组(CAP组),采用多因素方法分析CAP患者发生肺炎旁胸腔积液的独立影响因素,建立其ROC曲线预测模型。结果共343例CAP患者纳入分析,其中CAP-PE组176例(51.3%),与CAP组相比,CAP-PE组以男性和年龄≥65岁居多,合并基础疾病比例较高,且感染生物标志物和凝血功能明显异常。Logistic回归分析显示,外周血淋巴细胞、白蛋白和D-二聚体是影响CAP合并肺炎旁胸腔积液形成的独立影响因素。ROC曲线显示,将上述三个参数联合应用于肺炎旁胸腔积液形成的预测优于单个变量,其曲线下面积为0.815。结论CAP-PE组的临床指标明显异常于CAP组。经过多因素分析,外周血淋巴细胞、白蛋白和D-二聚体能预测肺炎旁胸腔积液的形成,将以上三个参数其联合分析时具有更优的预测价值。Objective To compare the underlying disease factors,laboratory examination,imaging data,and disease severity of Community-acquired pneumonia(CAP)with and without parapneumonic pleural effusion,and to analyze the clinical factors affecting CAP patients with parapneumonic pleural effusion.Methods The clinical data of CAP patients in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Soochow University from January 1,2018,to March 31,2022,were analyzed retrospectively,the patients were divided into pleural effusion(CAP-PE group)and without pleural effusion(CAP group).Multivariate analysis was used to analyze the independent influencing factors of the occurrence of parapneumonic pleural effusion in CAP patients,and the ROC curve prediction model was established.Results A total of 343 patients with CAP were included in the analysis,176(51.3%)were CAP-PE group.Compared with the CAP group,the CAP-PE group has more males and≥65 years old,with a higher proportion of underlying diseases,significantly abnormal inflammatory markers,and coagulation function.Logistic regression analysis showed that peripheral blood lymphocytes,albumin,and D-dimer were independent influencing factors for the formation of parapneumonic pleural effusion in CAP patients.ROC curve showed that the combination of the above three parameters was better than a single variable in predicting the formation of parapneumonic pleural effusion,with an AUC of 0.815.Conclusion The clinical indicators in the CAP-PE group are significantly different from those of the CAP group.Multivariate analysis showed that peripheral blood lymphocytes,albumin,and D-dimer can predict the formation of parapneumonic pleural effusion,and the combined analysis of the above three parameters has a better predictive value.

关 键 词：社区获得性肺炎 肺炎旁胸腔积液 独立影响因素 

分 类 号：R563.1[医药卫生—呼吸系统]