床旁肺超声B线计数及外周血嗜酸性粒细胞评估慢性阻塞性肺疾病并发肺炎的价值及其相关因素分析  

Bedside lung ultrasound B⁃line counting and peripheral blood eosinophil in diagnosing pneumonia in patients with chronic obstructive pulmonary disease and related factors

作　　者：史妹 周历安[1] 符叶柳[1] Shi Mei;Zhou Li’an;Fu Yeiu(Department of Ultrasound,Affiliated Haikou Hospital of Xiangya School of Medicine,Central South University,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院超声医学科,海南海口570208

出　　处：《海军医学杂志》2023年第12期1243-1247,共5页Journal of Navy Medicine

基　　金：海南省医药卫生科研项目(19A200093)。

摘　　要：目的探讨床旁肺超声B线计数及外周血嗜酸性粒细胞(EOS)对慢性阻塞性肺疾病(COPD)并发肺炎的诊断价值及相关因素。方法选取2019年8月至2021年8月中南大学湘雅医学院附属海口医院诊治的165例COPD患者作为研究对象,根据其有无并发肺炎分为肺炎组(n=55)和非肺炎组(n=110),比较2组患者B线计数、EOS百分数;采用受试者操作特征(ROC)曲线模型分析B线计数、EOS百分数诊断COPD患者并发肺炎的曲线下面积(AUC)、敏感度、特异度;采用二元Logistic回归模型分析影响COPD患者并发肺炎的危险因素。结果肺炎组B线计数、EOS百分数大于非肺炎组(P<0.05)。ROC曲线分析显示,B线计数、EOS百分数诊断COPD患者并发肺炎的AUC分别为0.850、0.759(P<0.05),敏感度分别为69.10%、60.00%,特异度分别为89.10%、84.50%。肺炎组与非肺炎组在年龄、抗生素使用时间、基础疾病、机械通气时间、糖皮质激素使用时间、多器官功能障碍综合征(MODS)等基线资料比较中,差异有统计学意义(P<0.05)。经二元Logistic回归分析显示,抗生素使用时间>14 d、机械通气时间≥10 d、糖皮质激素使用时间≥7 d、MODS是影响COPD患者并发肺炎的独立危险因素(P<0.05)。结论床旁肺超声B线计数及外周血EOS在诊断COPD患者并发肺炎中具有较高的临床价值,且抗生素使用时间、基础疾病、机械通气时间、糖皮质激素使用时间及MODS等因素会在一定程度上增加COPD患者并发肺炎的风险。Objective To investigate the value of bedside lung ultrasound B-line counting and peripheral blood eosinophil(EOS)in diagnosing chronic obstructive pulmonary disease(COPD)complicated with pneumonia and related factors.Methods A total of 165 COPD patients diagnosed and treated in Affiliated Haikou Hospital of Xiangya School of Medicine of Central South University from August 2019 to August 2021 were enrolled.Of them,55 had pneumonia(pneumonia group)and 110 did not have pneumonia(non-pneumonia group).B-line counting and EOS percentage were compared between the 2 groups.Receiver operating characteristic(ROC)curve was drawn to analyze the area under curve(AUC),sensitivity and specificity of B-line counting and EOS percentage in diagnosing pneumonia in COPD patients.Binary logistic regression model was used to analyze the risk factors affecting COPD patients complicated with pneumonia.Results The B-line counting and the percentage of EOS in the pneumonia group were significantly higher than those in the non-pneumonia group(P<0.05).ROC curve analysis showed that the AUC values of B-line counting and EOS percentage for the diagnosis of pneumonia in COPD patients were 0.850 and 0.759,respectively(P<0.05);the sensitivities were 69.10%and 60.00%,and the specificities were 89.10%and 84.50%.There were significant differences in the antibiotic use time,basis diseases,mechanical ventilation time,glucocorticoid use time,and the incidence of multiple organ dysfunction syndrome(MODS)between the 2 groups(P<0.05).Binary logistic regression analysis showed that age≥60 years old,antibiotic use time>14 d,mechanical ventilation time≥10 d,glucocorticoid use time≥7 d,and MODS were independent risk factors affecting the development of pneumonia in COPD patients(P<0.05).Conclusion Bedside lung ultrasound B-line counting and peripheral blood EOS have high clinical value in diagnosing pneumonia in COPD patients.Age,antibiotic use time,basic diseases,mechanical ventilation time,glucocorticoid use time,and MODS may increase the risk of p

关 键 词：床旁 肺超声 B线计数 嗜酸性粒细胞 慢性阻塞性肺疾病 肺炎 

分 类 号：R563.9[医药卫生—呼吸系统]