CHE、Lac、Lcr联合检测对重症SAP患者预后预测价值的研究

Predictive value of combined detection of serum cholinesterase, lactate and lactate clearance rate on the prognosis of patients with severe stroke associated pneunomia

目的:探讨血清胆碱酯酶(CHE)、乳酸(Lac)、乳酸清除率(Lcr)及联合检测对重症卒中相关性肺炎(SAP)患者预后的预测价值。方法:选取2016-09-2018-08期间急诊重症监护室(EICU)收治的116例重症SAP患者为研究对象,根据28 d是否存活分为存活组(67例)和死亡组(49例)。检测两组患者血CHE、入院时及入院24 h血Lac值;计算乳酸清除率及急性生理与慢性健康评分Ⅱ(APACHEⅡ)。分析各指标及指标联合检测对重症SAP患者预后的预测价值。结果:多因素非条件Logistic回归分析结果显示,APACHEⅡ评分、血清CHE、24 h Lac及Lcr对判断重症SAP预后具有统计学意义(P<0.05),受试者工作特征曲线(ROC曲线)下面积分别为0.682、0.670、0.634及0.690。联合指标曲线下面积为0.818,灵敏度和特异度分别为0.796和0.731。结论:APACHEⅡ评分、血清CHE、24 h Lac及Lcr可用于判断重症SAP预后,联合检测可显著提高预测价值。

Objective:Severe stroke associated pneumonia(SAP) patients with respiratory failure or septic shock have poor prognosis and high mortality. It is important to evaluate the severity and prognosis of SAP patients. To investigate the predictive value of serum cholinesterase(CHE), lactate(Lac), lactate clearance(Lcr) and combined detection in patients with severe SAP. Method:From September 2016 to August 2018, 116 patients with severe SAP were enrolled in EICU. According to the survival of 28 days, they were divided into survival group(67 cases) and death group(49 cases). Serum CHE, Lac at admission and 24 hours after admission were measured. Lcr and APACHE Ⅱ score was calculated. To analyze the predictive value of each index and combined detection in patients with severe SAP. Result:Multivariate unconditional Logistic regression analysis showed that APACHE Ⅱ score, serum CHE, 24 h Lac and 24 h Lcr had statistical significance in judging the prognosis of severe SAP(P<0.05), and the areas under ROC curve were 0.682, 0.670, 0.634 and 0.690, respectively. The area under the combined index curve was 0.818, and the corresponding sensitivity and specificity were 0.796 and 0.731, respectively. Conclusion:APACHE Ⅱ score, serum CHE, 24-hour Lac and Lcr can be used to judge the prognosis of severe SAP, and the combined detection can significantly improve the predictive value.