D-二聚体与社区获得性肺炎严重程度的关系及其预后价值  

Relationship between D-dimer and severity of community-acquired pneumonia and its prognostic value

作　　者：张艳艳 蒋亚林[1] ZHANG Yanyan;JIANG Yalin(Respiratory and Critical Care Medicine Department,Bozhou People′s Hospital,Bozhou,Anhui 236800,China)

机构地区：[1]亳州市人民医院呼吸与危重症学科,安徽亳州236800

出　　处：《临床肺科杂志》2025年第4期555-559,共5页Journal of Clinical Pulmonary Medicine

基　　金：安徽省卫生健康科研项目(AHWJ2023A20189)。

摘　　要：目的探讨D-二聚体与社区获得性肺炎(CAP)严重程度的相关性及对CAP的预后预测价值。方法回顾性分析2022年1月至2022年12月亳州市人民医院呼吸内科及重症医学科住院的CAP患者临床资料,分析D-二聚体水平与CAP严重程度、肺炎累及肺叶数及胸腔积液的相关性。根据PSI评分,CAP患者分低风险组(n=153)、高风险组(n=80)。绘制ROC曲线评估D-二聚体预测CAP患者30天内死亡的效能。结果低风险组和高风险组D-二聚体分别为0.51(0.32,0.84)mg/L、1.42(0.82,2.20)mg/L,差异有统计学意义(P<0.001)。多叶组D-二聚体水平[0.98(0.55,1.75)mg/L]明显高于单叶组[0.36(0.28,0.72)mg/L]及双叶组[0.50(0.34,0.81)mg/L](P<0.001)。CAP伴类肺炎性胸腔积液组[1.43(0.87,2.66)mg/L]与无胸腔积液组D-二聚体水平[0.56(0.34,1.10)mg/L]差异有统计学意义(P<0.001)。以患者是否30天内死亡绘制ROC曲线,PSI的AUC为0.909(95%CI:0.848~0.970),D-二聚体的AUC为0.891(95%CI:0.793~0.989),两者预测效能无统计学意义(P>0.05)。D-二聚体>1.535mg/L预测CAP住院患者30天死亡的敏感度90.9%,特异度82.0%。结论D-二聚体水平与CAP的严重程度相关,对CAP预后有较好的判断价值。Objective To explore the correlation between D-dimer and the severity of community-acquired pneumonia(CAP)and its prognostic value for CAP.Methods The clinical characteristics of CAP patients admitted to Department of Respiratory Medicine and Intensive Care Medicine of Bozhou People′s Hospital from January 2022 to December 2022,and the correlation of D-dimer levels with the severity of CAP,the number of lung lobes affected by pneumonia,and pleural effusion were analyzed.According to PSI score,the CAP patients were classified into the low risk group(n=153)and the high risk group(n=80).ROC curve was drawn to evaluate the efficacy of D-dimer to predict death within 30 days in patients with CAP.Results The D-dimer levels in the low-risk group and high-risk group were 0.51(0.32,0.84)mg/L and 1.42(0.82,2.20)mg/L,with statistically significant differences(P<0.001).The D-dimer levels in the multi-lobes group[0.98(0.55,1.75)mg/L]were significantly higher than those in the single-lobe[0.36(0.28,0.72)mg/L]and double-lobes group[0.50(0.34,0.81)mg/L](P<0.001).There was a statistically significant difference in D-dimer levels between the CAP group with parapneumonic pleural effusion[1.43(0.87,2.66)mg/L]and the group without pleural effusion[0.56(0.34,1.10)mg/L](P<0.001).The ROC curve was plotted based on whether the patient died within 30 days.The AUC of PSI was 0.909(95%CI:0.848-0.970),and the AUC of D-dimer was 0.891(95%CI:0.793-0.989).There was no statistically significant difference in the predictive efficacy between the two methods(P>0.05).D-dimer level over 1.535mg/L had a positive predict value for CAP in hospital 30-day death with a sensitivity of 90.9%and a specificity 82.0%.Conclusion The level of D-dimer is associated with the severity of CAP and has a good prognostic value in patients with CAP.

关 键 词：D-二聚体 社区获得性肺炎 肺炎严重指数 预后 

分 类 号：R563.1[医药卫生—呼吸系统]