红细胞分布宽度、胆碱酯酶、降钙素原对老年重症社区获得性肺炎病人28 d死亡风险的预测价值  

Predictive value of red blood cell distribution width,cholinesterase and procalcitonin on 28-day mortality risk of elderly patients with severe community-acquired pneumonia

作　　者：丁伟超 耿润露 周京江 李丽 徐磊 卢斌 叶英 DING Weichao;GENG Runlu;ZHOU Jingjiang;LI Li;XU Lei;LU Bin;YE Ying(Department of Emergency Medicine,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院急诊医学科,江苏徐州221002

出　　处：《安徽医药》2024年第10期1979-1983,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨红细胞分布宽度(RDW)、胆碱酯酶(CHE)、降钙素原(PCT)对老年重症社区获得性肺炎(SCAP)病人28 d死亡风险的预测价值。方法回顾性分析2016年1月至2021年12月入住徐州医科大学附属医院的86例老年SCAP病人的临床资料。根据28 d转归情况将病人分为生存组(n=50)与死亡组(n=36)。比较两组病人的一般资料以及入院24 h内的化验结果。结果死亡组病人的急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)、脓毒症相关性器官功能衰竭评价(SOFA)、白细胞计数、中性粒细胞(NEU)计数、RDW[(15.61±1.82)%比(13.89±1.35)%]、PCT[14.71(2.37,23.64)μg/L比0.46(0.19,3.29)μg/L]、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、乳酸(LAC)大于生存组,血小板(PLT)计数、白蛋白(ALB)、CHE[2920.00(1992.00,3638.00)IU/L比4443.00(3174.00,5275.00)IU/L]、pH、氧合指数(PaO2/FiO2)小于生存组(P<0.05)。多因素logistic回归分析显示RDW、CHE、PCT是老年SCAP病人死亡的独立危险因素(P<0.05)。Spearman相关分析显示,RDW与PCT呈正相关(r=0.30,P=0.005),RDW与CHE呈负相关(r=−0.30,P=0.005)。ROC曲线分析显示RDW、CHE、PCT预测老年SCAP病人死亡的AUC分别为0.75、0.71、0.75。联合指标行ROC曲线分析显示RDW+CHE、RDW+PCT、CHE+PCT、RDW+CHE+PCT预测老年SCAP病人死亡的AUC分别为0.81、0.87、0.84、0.92,联合指标对老年SCAP病人死亡的预测能力大于单一指标,RDW+CHE+PCT三项联合指标的预测能力最强。结论RDW和/或PCT升高、CHE降低是老年SCAP病人死亡的高危因素。而且,RDW、CHE、PCT对老年SCAP病人的28 d死亡风险存在预测价值,各指标联合预测价值更高。Objective To investigate the predictive value of red blood cell distribution width(RDW),cholinesterase(CHE)and procalcitonin(PCT)for 28-day mortality risk in elderly patients with severe community acquired pneumonia(SCAP).Methods The clinical data of 86 elderly patients with SCAP admitted to the Affiliated Hospital of Xuzhou Medical University from January 2016 to December 2021 were retrospectively analyzed.According to 28-day outcome,the patients were divided into survival group(n=50)and death group(n=36).General information and laboratory results within 24 hours after admission were compared between the two groups.Results Acute physiology and chronic health evaluation(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,white blood cell(WBC)count,neutrophil(NEU)count,RDW[(15.61±1.82)%vs.(13.89±1.35)%],PCT[14.71(2.37,23.64)μg/L vs.0.46(0.19,3.29)μg/L],C-reactive protein(CRP),interleukin-6(IL-6)and lactic acid(LAC)in the death group were higher than those in the survival group.Blood platelet(PLT)count,albumin(ALB),CHE[2920.00(1992.00,3638.00)IU/L vs.4443.00(3174.00,5275.00)IU/L],pH and oxygenation index(PaO2/FiO2)were lower than those in the survival group(P<0.05).Multivariate Logistic regression analysis showed that RDW,CHE and PCT were independent risk factors for death in elderly patients with SCAP(P<0.05).Spearman correlation analysis showed that RDW was positively correlated with PCT(r=0.30,P=0.005),RDW was negatively correlated with CHE(r=−0.30,P=0.005).ROC curve analysis showed that the AUC of RDW,CHE and PCT for predicting death in elderly patients with SCAP were 0.75,0.71 and 0.75,respectively.ROC curve analysis of combined indicators showed that the AUC of RDW+CHE,RDW+PCT,CHE+PCT and RDW+CHE+PCT for predicting death in elderly patients with SCAP were 0.81,0.87,0.84 and 0.92,respectively.The predictive ability of the combined indicator for death in elderly patients with SCAP was greater than that of the single indicator,and RDW+CHE+PCT had the strongest predictive power.Conclusion Increas

关 键 词：重症社区获得性肺炎(SCAP) 老年人 红细胞分布宽度 胆碱酯酶 降钙素原 预测价值 病死率 

分 类 号：R563.1[医药卫生—呼吸系统]