探讨血浆可溶性尿激酶型纤溶酶原激活物受体联合肺炎严重度指数评分用于评估社区获得性肺炎严重程度的价值

Predictive value of plasma su PAR combined with PSI score for community-acquired pneumonia severity

目的 探讨血浆可溶性尿激酶型纤溶酶原激活物受体（soluble urokinase plasminogen activator receptor,su PAR）联合肺炎严重度指数（pneumonia severity index,PSI）评分用于早期评估社区获得性肺炎（community acquired pneumonia,CAP）严重程度的临床价值。方法 选取2012年11月至2015年8月入住本院呼吸科和呼吸重症监护病房的重症社区获得性肺炎（severe community acquired pneumonia,SCAP）患者83例纳入SCAP组、普通CAP患者90例纳入CAP组,另选取健康志愿者80例纳入对照组。比较三组研究对象住院当天血清C反应蛋白（C-reaction protein,CRP）、白细胞（white blood cell,WBC）、降钙素原（procalcitonin,PCT）、血浆su PAR水平及PSI评分的差异,分析血浆su PAR联合PSI评分对CAP病情的预测价值及相关性。结果 三组研究对象入院24小时内除SCAP组和CAP组患者的WBC比较无显著差异（P=0.38）外,血清CRP、WBC、PCT和血浆su PAR水平三组间比较均具有显著差异（P〈0.01）。血浆su PAR水平随PSI分级的升高而升高,且在各分级患者间均具有显著性差异（P〈0.01）,而PCT和CRP水平在PSI分级Ⅲ、Ⅳ、Ⅴ级患者间均具有显著差异（P〈0.001）。suPAR水平与PSI评分具有相关性（r=0.254,P=0.001）。su PAR联合PSI评分评估肺炎严重程度的敏感度和特异度分别为85.1%、74.8%,接受者操作特征曲线（ROC曲线）下面积（AUC）为0.852（95%CI：80.1%~91.2%,P〈0.001）,高于单一指标su PAR（AUC 0.782）和PSI评分（AUC 0.805）。结论 早期监测血浆su PAR可以预测CAP病情严重程度,联合PSI评分可以显著增加早期的预测效能。

Objective To explore the predictive clinical value of plasma soluble urokinase plasminogen activator receptor （suPAR） combined with pneumonia severity index （PSI） score for evaluating：the severity of community acquired pneumonia （CAP）. Method 90 patients （SCAP group） with severe community acquired pneumonia and 83 patients （CAP group） with common CAP respiratory unitintensive care unit and department of respiratory medicine in our hospital were admitted from November 2012 to August 2015 in the study, 80 cases of healthy objects were treated as control group. Levels of serum C-reaction protein （CRP）, white blood cell （WBC）, procalcitonin （PCT） and plasma suPAR were compared among the three groups at 1^st day, PSI scores were recorded for all patients. The predictive clinical value and correlation of suPAR combined with PSI score for evaluating the severity of CAP were analyzed. Result The differences were statistically significant for the levels of surem CRP, WBC, PCT, plasma suPAR and PSI score among three groups （P ~ 0.01）. There were not significant for WBC differences between SCAP group and CAP group （P = 0.38）. Plasma suPAR level was significantly increased with the PSI grade （Pail ~ 0,01）, Plasma suPAR level correlated with the PSI scores （r ---- 0.254, P ---- 0.001）. The AUC was 0.852 （95%CI： 80.1% - 91.2%, P 〈 0.001） when suPAR combined with PSI score for diagnosis of severe pneumonia, the sensitivity was 85.1%, the specificity was 74.8%, which was higher than each single index （suPAR： AUC 0.782, PSI score： AUC 0.805）. Conclusion Early monitoring of plasma suPAR can determine and predict severity of CAP, suPAR combined with PSI score can significantly increase the early prediction efficiency.