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中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 157 -162. doi: 10.3877/cma.j.issn.1674-1358.2020.02.013

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论著

活化蛋白C、脑钠肽及APACHE Ⅱ评分在老年重症肺炎患者中的动态变化及与预后的相关性
张严1,(), 文小玲1   
  1. 1. 610000 成都市,成都市西区医院重症医学科
  • 收稿日期:2019-06-21 出版日期:2020-04-15
  • 通信作者: 张严

Dynamic changes of actived protein C, brain natriuretic peptide and acute physiology andchronic health evaluation Ⅱ score in senile severe pneumonia patients and the relationships with prognosis

Yan Zhang1,(), Xiaoling Wen1   

  1. 1. Department of Critical Care Medicine, Chengdu West District Hospital, Chengdu 610000, China
  • Received:2019-06-21 Published:2020-04-15
  • Corresponding author: Yan Zhang
  • About author:
    Corresponding author: Zhang Yan, Email:
引用本文:

张严, 文小玲. 活化蛋白C、脑钠肽及APACHE Ⅱ评分在老年重症肺炎患者中的动态变化及与预后的相关性[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(02): 157-162.

Yan Zhang, Xiaoling Wen. Dynamic changes of actived protein C, brain natriuretic peptide and acute physiology andchronic health evaluation Ⅱ score in senile severe pneumonia patients and the relationships with prognosis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(02): 157-162.

目的

探讨活化蛋白C(APC)、脑钠肽(BNP)及急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分在老年重症肺炎患者中的动态变化,并分析其与预后的相关性。

方法

选取2016年6月至2018年6月于成都市西区医院诊治的288例老年重症肺炎患者为研究对象,根据患者28天生存情况分为生存组(168例)和死亡组(120例)。用化学发光法和酶联免疫吸附法检测各组患者血清APC和BNP表达水平,用APACHE Ⅱ评分评估各组患者预后,分析两组患者入组后第1天、第4天和第7天APC、BNP和APACHE Ⅱ评分的动态变化;应用Logistic回归分析影响老年重症肺炎预后的危险因素,采用ROC曲线分析3项指标联合预测老年重症肺炎预后的价值。

结果

与死亡组患者相比,生存组患者入组后第1天、第4天和第7天BNP水平[(494.62 ± 34.82)pg/ml、(318.42 ± 27.42)pg/ml和(274.61 ± 20.84)pg/ml]和APACHE Ⅱ评分[(24.05 ± 4.82)、(18.62 ± 3.71)和(12.13 ± 2.62)]显著增高,差异均有统计学意义(P均< 0.001),但APC水平[(289.34 ± 18.39)ng/ml、(357.64 ± 32.71)ng/ml和(427.25 ± 18.45)ng/ml]则显著降低,差异均有统计学意义(t = 5.512、35.499、78.552,P均< 0.001)。生存组患者随住院时间延长,其BNP水平与APACHE Ⅱ评分逐渐降低(F = 24.538、P < 0.001;F = 12.945、P < 0.001),而APC水平则逐渐升高(F = 23.947、P < 0.001)。死亡组患者随住院时间的延长,其BNP水平[(749.14 ± 42.92)pg/ml、(814.62 ± 50.47)pg/ml和(904.25 ± 57.15)pg/ml]与APACHE Ⅱ评分[(28.34 ± 5.17)、(34.51 ± 6.35)和(39.55 ± 7.32)]逐渐升高,差异有统计学意义(F = 15.302、P < 0.001,F = 10.389、P < 0.001);而APC水平[(276.23 ± 21.84)ng/ml、(226.38 ± 28.26)ng/ml和(183.43 ± 33.81)ng/ml]逐渐下降,差异有统计学意义(F = 34.165、P < 0.001)。生存组和死亡组在吸烟史[36.90%(62/168) vs. 53.33(64/120)]、慢性呼吸系统病史[(46.43(78/168) vs. 65.83(79/120)]、氧分压[(83.27 ± 6.92)mmHg vs. (76.82 ± 8.65)mmHg]及机械通气方面[35.12(59/168) vs. 52.50(63/120)],差异均有统计学意义(χ2 = 7.677、P = 0.006,χ2 = 10.630、P = 0.001,t = 9.881、P < 0.001,χ2 = 8.661、P = 0.003)。Logistic回归分析显示,机械通气(OR = 4.627,P < 0.001)、APC(OR = 2.637,P = 0.012)、BNP(OR = 3.325,P = 0.005)和APACHE Ⅱ评分(OR = 4.831,P < 0.001)均为影响老年重症肺炎预后的独立危险因素。ROC曲线显示,与APC、BNP或APACHE Ⅱ评分单项指标预测比较,3项指标联合预测老年重症肺炎死亡的敏感性、特异性、阳性预测值及阴性预测值(89.42%、81.61%、84.72%和86.03%)均显著升高。

结论

APC、BNP和APACHE Ⅱ评分在老年重症肺炎疾病转归中变化明显,为影响老年重症肺炎预后的独立危险因素,3项指标联合可显著提高其预后预测价值。

Objective

To investigate the dynamic changes of activated protein C (APC), brain natriuretic peptide (BNP), acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) in elderly patients with severe pneumonia, and to analyze their relationship with the prognosis.

Methods

Total of 288 elderly patients with severe pneumonia who were treated in Chengdu West District Hospital from June 2016 to June 2018 were selected. They were divided into survival group (168 cases) and death group (120 cases) according to 28-day survival condition. The levels of serum APC and BNP of each group werer detected by chemiluminescence and enzyme-linked immunosorbent assay, respectively; and the status of each group were evaluated by APACHE Ⅱ score. The dynamic changes of APC, BNP and APACHE Ⅱ scores in each group at the first day, the fourth day and the seventh day were compared between the two groups, respectively. The risk factors of senile severe pneumonia were explored by Logistic regression analysis, and the value of the combined three indexes in predicting the prognosis of senile severe pneumonia was analyzed by ROC curve analysis.

Results

Compared with the death group, the levels of BNP [(494.62 ± 34.82) pg/ml, (318.42 ± 27.42) pg/ml and (274.61 ± 20.84) pg/ml] and APACHE Ⅱ score [(24.05 ± 4.82), (18.62 ± 3.71) and (12.13 ± 2.62)] of cases in survival group significantly increased at the first day, the fourth day and the seventh day, with significant differences (all P < 0.001), but the levels of APC [(289.34 ± 18.39) ng/ml, (357.64 ±32.71) ng/ml and (427.25 ± 18.45) ng/ml] decreased, with significant differences (t = 5.512, 35.499, 78.552; all P < 0.001). The BNP level and APACHE Ⅱ score of cases in survival group decreased with the extension of hospitalization time (F = 24.538, P < 0.001; F = 12.945, P < 0.001), while the level of APC increased gradually (F = 23.947, P < 0.001). In the death group, with the extension of hospitalization time, the levels of BNP and APACHE Ⅱ score increased gradually (F = 15.302, P < 0.001; F = 10.389, P < 0.001); while the levels of APC decreased gradually, with significant difference (F = 34.165, P < 0.001). There were significant differences in smoking history [36.90% (62/168) vs. 53.33 (64/120)], chronic respiratory disease history [46.43 (78/168) vs. 65.83 (79/120)], partial oxygen pressure [(83.27 ± 6.92) mmHg vs. (76.82 ± 8.65) mmHg] and mechanical ventilation [35.12 (59/168) vs. 52.50 (63/120)] between cases in survival group and death group (χ2 = 7.677, P = 0.006; χ2 = 10.630, P = 0.001; t = 9.881, P < 0.001; χ2 = 8.661, P = 0.003). Logistic regression analysis showed that mechanical ventilation (OR = 4.627, P < 0.001), APC (OR = 2.637, P = 0.012), BNP (OR = 3.325, P = 0.005) and APACHEE Ⅱ scores (OR = 4.831, P < 0.001) were all independent risk factors of senile severe pneumonia. Compared with the single prediction of APC, BNP and APACHE Ⅱ scores, the sensitivity, specificity, positive predictive value and negative predictive value of the combined prediction of severe pneumonia death in the elderly were significantly increased (89.42%, 81.61%, 84.72% and 86.03%).

Conclusions

APC, BNP and APACHEE Ⅱ scores change significantly in the progression of senile severe pneumonia, and were independent risk factors of senile severe pneumonia. The combination of the three indexes could significantly improve the prognostic predictive value.

表1 两组患者APC、BNP及APACHE Ⅱ评分动态变化(±s
表2 两组患者的临床资料
表3 影响老年重症肺炎预后危险因素的Logistic回归分析
图1 APC、BNP和APACHE Ⅱ评分预测老年重症肺炎死亡的ROC曲线
表4 APC、BNP和APACHE Ⅱ评分在预测老年重症肺炎死亡中的价值
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