多肺叶病变对社区获得性肺炎预后的影响

Prognosis of Multi-lobar Infiltrates in Community-acquired Pneumonia

目的观察多肺叶病变对社区获得性肺炎（community-acquired pneumonia,CAP）预后的影响。方法收录105例CAP患者,记录一般资料、肺部病变情况、肺炎严重指数（pneumonia severity index,PSI）、CURB-65评分、30 d内生存情况,用SPSS17.0进行统计分析。结果多肺叶病变组（74例）平均年龄高于单肺叶病变组（39例）,分别为（64.26±16.90）vs（55.55±19.87）岁,P=0.024。与单肺叶病变组比较,多肺叶病变组肺炎严重指数PSI明显升高[（98.99±46.33）vs（79.10±35.09）,P=0.034];脓毒血症发生率略高（55.4%vs 35.5%,P=0.063）;30 d内病死率高（12.2%vs 0%,P=0.042）。将多肺叶病变记为1分,联合CURB-65评分,可将预测CAP死亡风险的ROC曲线下面积从0.837提升至0.861[95%CI,0.608-1.000],P=0.000。结论多肺叶病变对社区获得性肺炎预后评估具有一定的价值,将其联合CURB-65评分可能会提高后者的效能。

Objective To investigate the impact of multi-lobar infiltrates involvement in community-acquired pneumonia（CAP）. Methods 105 cases with community-acquired pneumonia were included, while the general information, pulmonary infiltrates, 30-day-suvival, pneumonia severity index（PSI）, and CURB-65 scores were recorded. Results The cases with multi-lobar infiltrates had a higher average age than those with single-lobar infiltrate [（64.26±16.90）vs（55.55±19.87）years, P=0.024]. Compared to those cases with single-lobar infiltrate, the cases with multi-lobar infiltrates had higher PSI [（98.99±46.33） vs（79.10±35.09）, P=0.034], higher incidence of sepsis（55.4% vs 35.5%, P=0.063） and higher mortality during 30 days（12.2% vs 0%, P=0.042）. The combination of CURB-65 scores and multi-lobar infiltrates which was recorded as one score, could be a better indicator for predicting 30-day-death because of a higher area under the ROC curve which was 0.861 [95% CI, 0.608-1.000, P =0.000] than that was 0.837 for CURB-65 scores. Conclusions Multi-lobar infiltrates appears to be a useful indicator for mortality in CAP. The combining both multi-lobar infiltrates and CURB-65 scores may improve the accuracy in predicting prognoses.