血清前清蛋白、C反应蛋白及载脂蛋白A1对重症肺炎患者预后评估的价值

Evaluation of the prognosis of the patients with severe pneumonia by observing prealbumin, C-reactive protein and apolipoprotein A1

目的探讨血清前清蛋白(PAB)、C反应蛋白(CRP)及载脂蛋白A1(Apo A1)在评估重症肺炎患者预后中的价值。方法选取63例重症肺炎患者,检测入院后24h内空腹血清PAB、CRP及Apo A1,并计算急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ);按患者APACHEⅡ评分值将患者分为两组(<20分为A组,≥20分为B组),分析两组患者多器官功能障碍综合征(MODS)发生率和病死率。将患者分为MODS组及非MODS组,并根据转归将患者分为存活组和死亡组,比较各组患者的血清PAB、CRP及Apo A1水平的差异。结果 B组MODS发生率和病死率(57.9%,47.4%)均显著高于A组(24.0%,16.0%),差异有统计学意义(P<0.01,P<0.05)。MODS组[(134.13±36.20)mg/L,(0.62±0.21)g/L]及死亡组[(129.05±52.24)mg/L,(0.76±0.29)g/L]PAB、Apo A1分别低于非MODS组[(215.03±72.08)mg/L,(1.06±0.39)g/L]及存活组[(185.52±57.63)mg/L,(1.15±0.36)g/L],差异有统计学意义(P<0.05),而MODS组(102.37±35.65)mg/L及死亡组(96.37±34.72)mg/L CRP分别高于非MODS组(69.68±32.92)mg/L及存活组(62.94±38.36)mg/L(P<0.05)。结论血清PAB、CRP和Apo A1这3种急性时相蛋白对于评估重症肺炎患者病情的危重程度及预后具有一定的价值。

Objective To study the value of prealbumin（PAB） ,C reactive protein（CRP） and apolipoprotein A1（Apo A1） in e-valuating the prognosis of patients with severe pneumonia .Methods 63 cases of patients with severe pneumonia were selected ,and the fasting serum level of prealbumin ,C-reactive protein and apolipoprotein A1 were detected in 24 hours at the admission day ,and APACHE Ⅱ score was calcumulated .The patients were divided into group A （APACHEⅡscore 〈20） and group B（APACHEⅡscore≥20） ,with the incidence of MODS and mortality rate compared .The patients were divided into non-MODS group and MODS group .In addition ,the patients were divided into survival group and death group according to the prognosis .PAB ,CRP and Apo A1 in each group were compared .Results The incidence of MODS and mortality rate in group B （57 .9% ,47 .4% ） were higher than that in group A（24 .0% ,16 .0% ）（P〈0 .01 ,P〈0 .05） .PAB and Apo A1 of patients in MODS group[（134 .13 ± 36 .20）mg/L , （0 .62 ± 0 .21）g/L] and death group[（129 .05 ± 52 .24）mg/L ,（0 .76 ± 0 .29）g/L] were respectively lower than that in non-MODS group[（215 .03 ± 72 .08）mg/L ,（1 .06 ± 0 .39）g/L] and survival group[（185 .52 ± 57 .63）mg/L ,（1 .15 ± 0 .36）g/L]（P〈0 .05） , while the CRP in MODS group（102 .37 ± 35 .65）mg/L and death group（96 .37 ± 34 .72）mg/L were higher than that in non-MODS group（69 .68 ± 32 .92）mg/L and survival group（62 .94 ± 38 .36）mg/L （P〈0 .05） .Conclusion The measurement of PAB ,CRP and Apo A1 are valuable to evaluate the prognosis of the patients with severe pneumonia .