炎症及营养指标对RICU下呼吸道感染患者临床转归预测分析

Value of inflammation and nutrition indexes in the prediction of clinical turnover in patients with lower respiratory infection in RICU

目的探讨炎症及营养指标对严重下呼吸道感染患者临床转归的预测价值。方法运用受试者工作特征曲线(ROC曲线)计算曲线下面积(AUC),分析143例呼吸重症监护病区(RICU)下呼吸道感染患者入院时血清降钙素原(PCT)、超敏C反应蛋白(Hs-CRP),清蛋白(Alb)、前清蛋白(PA)、尿素氮(BUN)、肌酐(Cr)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血红蛋白(Hb)水平和淋巴细胞计数(LY)等指标对于入院25 d死亡及实施机械通气的预测价值,进行炎症与营养指标的相关性分析。结果 ROC曲线对于25 d死亡预测分析中,PCT的AUC值最高(>0.70),其余指标AUC均>0.50。25 d死亡组与非死亡组间各指标比较,LY、PCT、Alb及PA的差异有统计学意义(P<0.05或P<0.01)。各指标预测实施机械通气ROC曲线分析中,LY的AUC值最高,除PA和Cr外,各指标AUC均>0.50。实施机械通气与未实施机械通气组间比较,LY、PCT、Hb及HDL-C的差异有统计学意义(P<0.05)。患者PCT与Hb、PA、Alb、TC、HDL-C及LDL-C水平呈负相关(P<0.05或P<0.01),与BUN及Cr水平呈正相关(P<0.01);Hs-CRP与PA、Alb水平呈负相关(P<0.01)。结论 PCT、LY对于严重下呼吸道感染患者近期死亡及实施机械通气独立预测价值相对较高,且PCT水平与营养状况有密切关系。

Objective To discuss the value of inflammation and nutrition indexes in the prediction of clinical turnover in patients with lower respiratory infection in RICU. Methods The receiver operating characteristic curve （ ROC curve） was used to calculate the area under the curve（AUC）in order to analyze the value of the indexes below in the prediction of death within 25 days after the admission and the application of mechanical ventilation. The indexes included PCT, Hs-CRP, Alb, PA, Bun, Cr, TC, TG, HDL- C, LDL-C, Hb, and LY of the 143 patients with lower respiratory infection at the time of admission in RICU. The correlation between the inflammation and the nutritive indexes was analyzed. Results Based on ROC curve analysis of death within 25 d,the AUC of PCT was the highest （ 〉 0.70）, and the AUCs of other indexes were all larger than 0.50. There were significant differences in LY, PCT, Alb, and PA between the death within 25 days group and non-death group （ P 〈 0.05 ）. In the ROC curve of the prediction of mechanical ventilation application,the AUC of LY was the highest, and the AUCs of other indexes were all larger than 0.50 except PA and Cr. There were significant differences in the LY, PCT, Alb, and PA between the groups receiving and not receiving the mechanical ventilation（ P 〈 0.05 ）. There was a negative correlation between the level of PCT and Hb, PA, Alb ,TC, HDL-C, and LDL-C （P 〈 0.05 or P 〈 0.01 ）and a positive correlation between the level of Bun and Cr（ P 〈 0.01 ）. There was a negative correlation between the level of Hs-CRP and PA and Alb （P 〈 0.01 ）. Conclusion PCT and LY have a great independent value in the prediction of the recent death and the application of mechanical ventilation in patients with severe lower respiratory infection, and the PCT level is closely related to the nutriture.