[1]梅春霞,刘娟,徐智,等.APACHEⅡ评分和降钙素原对肺部感染预后的预测作用[J].第三军医大学学报,2014,36(08):802-805.
 Mei Chunxia,Liu Juan,Xu Zhi,et al.Predictive value of APACHE Ⅱ score and procalcitonin in prognosis of patients with pulmonary infection[J].J Third Mil Med Univ,2014,36(08):802-805.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
36卷
期数:
2014年第08期
页码:
802-805
栏目:
论著
出版日期:
2014-04-30

文章信息/Info

Title:
Predictive value of APACHE Ⅱ score and procalcitonin in prognosis of patients with pulmonary infection
作者:
梅春霞刘娟徐智戢福云吴国明
第三军医大学新桥医院全军呼吸内科研究所,全军呼吸病研究重点实验室
Author(s):
Mei Chunxia Liu Juan Xu Zhi Ji Fuyun Wu Guoming
Institute of  Respiratory Diseases, Key Laboratory of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
关键词:
APACHEⅡ评分降钙素原肺部感染
Keywords:
acute physiology and chronic health evaluation Ⅱ  score procalcitonin pulmonary infection
分类号:
R44;R563.1
文献标志码:
A
摘要:
目的      探讨APACHEⅡ评分和降钙素原对重症监护室肺部感染患者预后的预测价值。      方法      收集2012年3月到2013年5月本院重症监护室肺部感染患者的临床资料,包括年龄、性别、APACHEⅡ评分、动脉血气、血沉、C-反应蛋白、乳酸、降钙素原、28 d结局、ARDS发生情况等, 绘制受试者工作特征曲线,比较APACHEⅡ评分和降钙素原对肺部感染患者28 d结局及并发ARDS的预测价值。      结果      纳入患者78例,其中28 d内死亡19例,1周内发展为ARDS 33例。死亡组APACHEⅡ评分和降钙素原显著高于存活组,分别为[(23.3±7.5) vs (15.5±6.2),P<0.001]和[18.6(1.5~25.0)ng/mL vs 1.0(0.3~25.0)ng/mL,P=0.044],氧合指数低于存活组,为[(189.7±89.4) vs (238.0±91.7),P=0.048]。ARDS组APACHEⅡ评分和降钙素原显著高于非ARDS组,分别为[(19.9±8.3) vs (15.6±6.0),P=0.013]和[8.3(1.2~25.0)ng/mL vs 0.7(0.2~21.8)ng/mL,P=0.016],氧合指数低于非ARDS组,为[(190.9±82.6 )vs (252.1±92.4),P=0.003]。APACHEⅡ评分和降钙素原对28 d结局有一定预测作用,APACHEⅡ评分的预测作用大于降钙素原(AUROC:0.797 vs 0.652,P=0.057)。APACHEⅡ评分和降钙素原对并发ARDS也有一定预测作用,两者预测作用相当(AUROC:0.651 vs 0.657,P=0.929)。APACHEⅡ评分和降钙素原联合后对28 d结局及并发ARDS的预测作用较两者单独的预测作用无显著提高。      结论      APACHEⅡ评分和降钙素原可以作为肺部感染预后的预测指标,有助于临床早期甄别预后差及具有ARDS高危倾向的患者。
Abstract:
Objective      To investigate whether acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and plasma procalcitonin are valuable predictors on the prognosis in patients with pulmonary infection.        Methods      Patients (n=78) with pulmonary infection in ICU from March 2012 to May 2013 were recruited from Xinqiao Hospital. The data including age, gender, APACHE Ⅱ score, blood gas analysis, erythrocyte sedimentation, C-reactive protein, lactic acid, procalcitonin, mortality within 28 d, occurrence of acute respiratory distress syndrome(ARDS), and so on were collected and analyzed using the receiver operating characteristic curve.       Results      Among the 78 patients with pulmonary infection, 19 were death cases and 33 were ARDS cases. The statistical analysis showed that as compared to the survival group, APACHE Ⅱ score and procalcitonin level were significantly higher while the oxygenation index was lower in the death group [23.3±7.5 vs 15.5±6.2, P<0.001; 18.6(1.5-25.0) vs 1.0(0.3-25.0)ng/mL, P=0.044; 189.7±89.4 vs 238.0±91.7, P=0.048, respectively]. Similarly, though both of APACHE Ⅱ score and procalcitonin level were also significantly higher and the oxygenation index was significantly lower in those who developed ARDS than in those who did not [19.9±8.3 vs 15.6±6.0, P=0.013; 8.3(1.2-25.0) vs 0.7(0.2-21.8)ng/mL, P=0.016; 190.9±82.6 vs 252.1±92.4, P=0.003, respectively]. Additionally, the results revealed that APACHE Ⅱ score or procalcitonin level could solely predicate the occurrence of ARDS (0.651 vs 0.657, P=0.929) and mortality within 28 d (0.797 vs 0.652, P=0.057). However, no improvement was found when the two predictors were combined together.       Conclusions      Both APACHE Ⅱ score and procalcitonin level are valuable in predicting the prognosis of patients with pulmonary infection, and help identify patients with high risks of death or ARDS.

参考文献/References:

梅春霞, 刘娟, 徐智, 等. APACHEⅡ评分和降钙素原对肺部感染预后的预测作用[J].第三军医大学学报,2014,36(8):802-805.

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更新日期/Last Update: 2014-04-21