摘要
目的分析临床肺部感染评分(CPIS评分)和血清降钙素原(PCT)在慢性阻塞性肺疾病呼吸机相关性肺炎(VAP)中的诊断价值和预后价值。方法采用回顾性分析的方法,将2015年2月至2018年2月在解放军第四五一医院干部病房及解放军第四五五医院老年医学科的100例(前者单位纳入21例,后者单位纳入79例)慢性阻塞性肺疾病无VAP的患者归为非VAP组,同期纳入100例(前者单位纳入24例,后者单位纳入76例)确诊为慢性阻塞性肺疾病VAP的患者归为VAP组。检测所有患者血清PCT水平,测定CPIS评分。比较VAP组与非VAP组患者CPIS评分和PCT水平;比较VAP患者中死亡组和存活组中CPIS评分、血清PCT水平;比较CPIS>6分组和CPIS≤6分患者血清PCT水平、COPD临床调查问卷(CCQ)问卷评分;分析CPIS与血清PCT的关系,CPIS与CCQ问卷的关系;以CPIS为6分为截断值,PCT为0.74 ng/ml为截断值分析CPIS+PCT在慢性阻塞性肺疾病VAP中的诊断价值和预后判断价值。结果VAP组患者CPIS评分、血清PCT水平均均较非VAP组高,P<0.05;死亡组CPIS评分、PCT水平均较存活组高,差异有显著性(P<0.05)。CPIS>6分组血清PCT水平、CCQ问卷评分均较CPIS≤6分组高,差异有显著性(P<0.05);相关性分析发现,CPIS与血清PCT呈正相关相关(r=0.492,P<0.05);CPIS与CCQ问卷存在正相关系(r=0.745,P<0.01)。CPIS联合PCT在慢性阻塞性肺疾病VAP诊断中的特异度为93.51%,敏感度为74.56%,在预后中的特异度、敏感度为79.37%、74.56%。结论 CPIS评分与CCQ问卷、血清PCT均存在相关性,高CPIS评分、高血清PCT预示着VAP及不良预后,两者联合将有利于慢性阻塞性肺疾病VAP的诊断和预后判断。
Objective To analyze the diagnostic and prognostic value of clinical pulmonary infection score（ CPIS） and serum procalcitonin（ PCT） in patients with chronic obstructive pulmonary disease（ COPD） associated with ventilator-associated pneumonia（ VAP）. Methods A retrospective analysis method was used to categorize 100 COPD patients without VAP from February 2015 to February 2018 as non-VAP group,and 100 COPD patients associated with VAP were classified as VAP group. PCT level and CPIS were measured in all patients. The CPIS and PCT level were compared between two groups. The CPIS and serum PCT level were compared between death group and survival group in VAP patients.The serum PCT levels in patients with CPIS 6 and CPIS≤6 were compared with those in COPD questionnaire score of the questionnaire（ COQ）;Analysis of the relationship between CPIS and serum PCT,CPIS and CCQ questionnaire was performed; To take CPIS 6 points for the cut-off value,PCT 0. 74 ng/ml for cut-off value to analyze the diagnostic and prognostic value of CPIS ＋ PCT. Results The CPIS and serum PCT level of VAP group were higher than those of non-VAP group（ P〈0. 05）. CPIS score and PCT level of death group were higher than that of VAP group（ P〈0. 05）. The correlation between CPIS and serum PCT,Pearson correlation coefficient（ r = 0. 492,P〈0. 05）. Correlation between CPIS and serum PCT level,CCQ questionnaire score were higher than that of CPIS≤6 group（ P〈0. 05） CCQ questionnaire（ r = 0. 745,P〈0. 01）.The specificity of CPIS combined with PCT in diagnosis of VAP in COPD patients was 93. 51%,sensitivity was 74. 56%,sensitivity and specificity in prognosis were 79. 37%,74. 56%,respectively. Conclusion There is correlations between the CPIS score and the CCQ questionnaire,the serum PCT. High CPIS score and serum PCT are predictive factors of VAP and poor prognosis. The combination of the two will be helpful for the diagnosis and prognosis of COPD associated with VAP.
作者
谢柏梅
敬梅
路晓艳
张彦海
魏俊
秦毅
XIE Bai-mei;JING Mei;LU Xiao-yan(Cadre Ward,The 451th Hospital of Chinese People＇s Liberation Army,Xi＇an Shaanxi 710054,China;Department of Geriatrics,The 455th Hospital of Chinese People＇s Liberation Army,Shanghai 200052,China.)
出处
《临床和实验医学杂志》
2018年第15期1617-1620,共4页
Journal of Clinical and Experimental Medicine
基金
陕西省社会发展科技攻关项目(编号:2015SF213)
关键词
慢性阻塞性肺疾病
呼吸机相关性肺炎
临床肺部感染评分
降钙素原
诊断
预后
Procalcitonin
Clinical lung infection score
Chronic obstructive pulmonary disease
Ventilator-associated pneumonia
Diagnosis
Prognosis
