不同年龄组重症社区获得性肺炎预后危险因素分析  

The risk factors of prognosis in patients with severe community-acquired pneumonia in different age groups

作　　者：张康 杨浩 荆惠 关胜男 张庆 谢凯 王海峰[1,2,3] Zhang Kang;Yang Hao;Jing Hui;Guan Shengnan;Zhang Qing;Xie Kai;Wang Haifeng(Dept of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000;The First Clinical Medical College,Henan University of Chinese Medicine,Zhengzhou 450003;Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan&Education Ministry of China,Zhengzhou 450003)

机构地区：[1]河南中医药大学第一附属医院呼吸与危重症医学科,郑州450000 [2]河南中医药大学第一临床医学院,郑州450003 [3]呼吸疾病中医药防治省部共建协同创新中心,郑州450003

出　　处：《安徽医科大学学报》2025年第3期558-564,共7页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金项目(编号:82074411、81774222);河南省高校科技创新团队支持计划项目(编号:22IRTSTHN029);河南省中医药科学研究专项课题重大专项项目(编号:2021ZYZD04);河南省中医药科学研究专项课题项目(编号:2022ZYFY04);河南省中医药拔尖人才培养项目(编号:2019ZYBJ05)。

摘　　要：目的 探讨不同年龄组重症社区获得性肺炎(SCAP)预后危险因素。方法 采用多中心、前瞻性的研究方法,分析2017年12月—2021年10月,河南中医药大学第一附属医院等11家三甲医院收治的住院SCAP患者的临床资料。根据患者年龄分为老年组(≥65岁)和非老年组(18~64岁),分析SCAP临床特征。根据死亡与否分为存活组与死亡组,通过多因素Logistic回归分析确定SCAP死亡的危险因素。结果 170例SCAP患者被纳入研究,年龄20~93 (65.75±15.23)岁,其中老年SCAP比例为58.82%(100/170)。非老年SCAP住院病死率为24.3%(17/70),老年SCAP住院病死率为28%(28/100)。与非老年SCAP相比,老年SCAP入院时病情严重程度评分更高,合并症更多,但入院时发热、呼吸频率增快症状表现更不明显。多因素Logistic回归分析显示,入院时肺炎严重指数(PSI)评分(P=0.016,OR=1.022, 95%CI 1.004~1.041)和有创机械通气(P=0.037,OR=4.543, 95%CI 1.092~18.898)为非老年SCAP住院死亡的独立危险因素,入院时序贯性脏器功能衰竭(SOFA)评分(P=0.006,OR=1.240, 95%CI 1.063~1.446)和合并冠心病(P=0.037,OR=2.834, 95%CI 1.066~7.534)为老年SCAP住院死亡的独立危险因素。结论 SCAP患者住院病死率高,入院时PSI评分和有创机械通气为非老年SCAP住院死亡的独立危险因素,入院时SOFA评分和合并冠心病为老年SCAP住院死亡的独立危险因素。Objective To explore the risk factors of prognosis in patients with severe community-acquired pneumonia(SCAP)in different age groups.Methods A multi-center and prospective study was conducted at 11 teaching hospitals in China from December 2017 to October 2021.Patients who met the criteria were assigned to the elderly group(≥65 years)and the non-elderly group(18-64 years)to demonstrate the clinical characteristics of SCAP.Patients were divided into survival group and death group according to whether they died in hospital,to determine the risk factors associated with mortality by multivariate logistic regression analysis.Results A total of 170 patients with SCAP were included in the study.The age of SCAP was 20-93(65.75±15.23)years old,and the proportion of SCAP in the elderly was 58.82%(100/170).In-hospital mortality of non-elderly SCAP was 24.3%(17/70),and the in-hospital mortality of elderly SCAP was 28%(28/100).Compared with non-elderly group,patients in elderly group had higher severity score and more complications on admission,but the symptoms of fever and respiratory rate at admission were less obvious.In multivariable logistic regression analysis,the factors significantly associated with in-hospital mortality of non-elderly SCAP were pneumonia severity index(PSI)score(P=0.016,OR=1.022,95%CI 1.004-1.041)and invasive mechanical ventilation(P=0.037,OR=4.543,95%CI 1.092-18.898)on admission,and the risk factors associated with in-hospital mortality in elderly SCAP were sequential organ failure assessment(SOFA)score(P=0.006,OR=1.240,95%CI 1.063-1.446)and combined with coronary artery disease on admission(P=0.037,OR=2.834,95%CI 1.066-7.534).Conclusion In-hospital mortality for SCAP is high.PSI score and invasive mechanical ventilation are risk factors for in-hospital mortality of non-elderly patients with SCAP,and SOFA score and combined with coronary artery disease on admission are risk factors for in-hospital mortality of elderly patients with SCAP.

关 键 词：重症社区获得性肺炎 老年 病死率 危险因素 SOFA评分 PSI评分 

分 类 号：R563.1[医药卫生—呼吸系统]