重症下呼吸道感染患者ChE与营养、炎症及预后的关系探讨

Correlation between ChE of patients with severe infection of LRT and nutrition, inflammation and prognosis

目的探讨重症下呼吸道感染患者入院时胆碱酯酶(ChE)水平与营养、炎症及对预后的关系。方法选取入院即收入重症医学科的重症下呼吸道感染患者40例,入院24 h内检测患者血清ChE、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白蛋白(Alb)、前白蛋白(PA)、总胆固醇(TC)水平和淋巴细胞计数(LY);以患者存活和死亡作为预后指标,分析入院时营养及炎症指标对预后的影响;作ChE与PCT、hs-CRP、Alb、PA、TC及LY等营养及炎症指标的相关性分析;将预后纳入状态变量,进行Alb、ChE及PCT的受试者工作特征(ROC)曲线分析。结果死亡组入院时血清Alb及ChE水平低于存活组(P<0.01),PCT水平高于存活组(P<0.05)。所有40例血清ChE水平与Alb、PA及TC呈正相关(r=0.728,P<0.001;r=0.569,P<0.001;r=0.464,P=0.003);与PCT水平呈负相关(r=-0.369、P=0.019);患者血清Alb、ChE和PCT对预后预测的曲线下面积(AUC)分别为0.844、0.817和0.741。Alb达临界值≥31.85 g/L时,预测患者预后的灵敏度(Se)为0.857,特异度(Sp)为0.833;当ChE临界值≥3.28×103U/L时,预测患者预后的Se为0.893,Sp为0.667;当PCT≥2.895 ng/ml时,预测预后的Se为0.583,Sp为0.893。结论重症下呼吸道感染患者入院时ChE水平与营养状况及炎症水平密切相关,并与Alb及PCT一样,可独立作为预测预后的指标。

Objective To explore the correlation between the cholinesterase （ChE） of the patients with severe infection of the lower respiratory tract （LRT） checked during the admission and the nutrition, inflammation and prognosis. Methods A total of 40 patients with severe infection of the LRT admitted to ICU were selected. The levels of ChE, PCT, hs-CRP, Alb, PA, TC and LY count in such patients were detected within 24 h upon the admission; the impacts of the nutrition indicators and inflammation markers upon admission on the prognosis were analyzed with the survival and death of patients as prognostic indicators; the correlation between ChE and PCT, hs-CRP, Alb, PA, TC, LY and other nutrition indicators and inflammation markers was also analyzed; the prognosis was included as a state variable for the analysis of ROC curve of Alb, ChE and PCT. Results The levels of Alb and ChE in the death group upon admission were lower than those in the survival group （P 〈 0.01）, while PCT level was higher than that in the survival group （P 〈 0.05）. The level of ChE in the 40 patients was positively correlated to the levels of Alb, PA and TC （r = 0.728, P 〈 0.001; r = 0.569, P 〈 0.001; r = 0.464, P = 0.003） and negatively correlated to the level of PCT （r = -0.369, P=0.019）; the AUCs for the prognostic prediction corresponding to the levels of Alb, ChE and PCT were 0.844, 0.817 and 0.741 respectively. When the critical value of Alb ≥ 31.85 g/L, the Se for prognostic prediction was 0.857 and the Sp was 0.833; when the critical value of ChE i〉 3.28x 103U/L, the Se for prognostic prediction was 0.893 and the Sp was 0.667; when the critical value of PCT ≥ 2.895 ng/ml, the Se was 0.583 and the Sp was 0.893. Conclusion The level of ChE in patients with severe infection of the LRT upon admission is closely correlated to the nutritional statns and the level of inflammation of the patients, and can be used as an indicator for prognosis independently just as Alb and PCT