简化临床肺部感染评分对无创通气治疗AECOPD呼吸衰竭的疗效评估

Predictive Value of Simplified Version of Clinical Pulmonary Infection Score for Efficacy of Noninvasive Ventilation Therapy in Patients with Acute Exacerbation of COPD

目的探讨肺部感染严重程度对无创通气治疗慢性阻塞性肺部疾病急性加重(AECOPD)呼吸衰竭的疗效影响,并评价临床肺部感染评分(CPIS)及简化CPIS是否可以成为预测无创通气效果的重要临床指标。方法对入选的84例AECOPD呼吸衰竭患者进行无创通气治疗,分别采集上机当天的体温、白细胞计数、气管分泌物性状、X线胸片、肺部浸润影的进展情况和气管吸取物培养状况,以及上机前和上机2 h后的血气分析、临床症状、体征变化,计算各自的CPIS和简化CPIS。并根据无创通气疗效将患者分为无创通气有效组(52例)和无效组(32例)。平行对照研究两组之间CPIS和简化CPIS的差别,分别对CPIS和简化CPIS进行各自对于无创通气疗效的受试者工作特征曲线(ROC曲线)分析。结果相关性分析研究显示CPIS、简化CPIS与无创通气疗效有显著负相关性(P<0.05)。有效组的CPIS和简化CPIS(4.0±2.8,3.2±2.4)明显低于无效组(8.0±2.1,7.2±1.8)(P=0.006,0.007)。ROC曲线分析显示CPIS、简化CPIS曲线下面积(AUC)分别为0.884和0.914(P均<0.001)。CPIS判定无创通气疗效的关键点为≤6,其敏感性为78.0%,特异性为91.2%;简化CPIS的关键点为≤5,其敏感性80.0%,特异性为91.2%。结论肺部感染的严重程度是影响AECOPD呼吸衰竭患者无创通气成功与否的重要因素;简化CPIS能够反映肺部感染的严重程度,是预测无创通气疗效的良好指标;简化CPIS≤5时可作为无创通气有效的预测指标。

Objective To investigate the influence of pulmonary infection on noninvasive ventilation （NIV） therapy in hypercapnic acute respiratory failure （ARF） due to acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, and evaluate the predictive value of simplified version of clinical pulmonary infection score （CPIS） for the efficacy of NIV therapy in ARF patients with AECOPD. Methods Eighty-four patients with ARF due to AECOPD were treated by NIV, and were divided into a successful group and an unsuccessful group by the therapeutic effect of NIV. The CPIS and simplified version of CPIS between two groups was compared. The predictive value of simplified version of CPIS for the efficacy of NIV was evaluated using ROC curve analysis. Results The CPIS and the simplified version of CPIS of the successful treatment group （4.0 ±2. 8,3.2 ±2.4） were lower than those of the unsuccessful group （8. 0±2. 1,7.2 ± 1.8 ） significantly （P = 0. 006,0. 007）. The area under ROC curve （AUC） of CPIS and simplified version of CPIS were 0. 884 and 0. 914 respectively, the cut point of CPIS and simplified version of CPIS were 6 （ sensitivity of 78.0%, specificity of 91.2% ） and 5 （ sensitivity of 80.0%, specificity of 91.2% ） respectively. Conclusions The level of pulmonary infection is an important influencing factor on the therapeutic effect of NIV in patients with ARF due to AECOPD. Simplified version of CPIS is a helpful predictor for the effect of NIV on ARF of AECOPD.