老年重症社区获得性肺炎患者临床危险因素分析

Analysis on risk factors for severe community acquired pneumonia in the elderly

目的探讨老年重症社区获得性肺炎患者临床危险因素，为临床防治提供依据。方法选择我院2013年1月至2015年7月收治的老年重症社区获得性肺炎64例患者作为重症组，同期收住院100例老年非重症社区获得性肺炎作为对照组。分别在入院24 h内，调查临床资料，采集病史，检测血清生化、凝血指标纤维蛋白降解产物、D－二聚体、炎症指标降钙素原。对相关资料进行单因素分析，将单因素分析中有显著性差异的变量进行Logistic回归分析。结果单因素分析显示，与对照组比较，重症组合并脑血管疾病[（82.21%（53/64）与32%（32/100）]、呼吸衰竭[60.93%（39/64）与1%（1/100）]、多种基础病[84.37%（54/64）与54%（54/100）]、误吸[90.62%（58/64）与28%（28/100）]、卧床[59.37%（38/64）与11%（11/100）]均明显高于对照组，两组比较差异均有统计学意义（P〈0.01或P〈0.05）；重症组病死率[56.62%（36/64）]高于对照组[3% （3/100）]，两组比较差异有统计学意义（P＝0.001）。重症组血清白蛋白[（27.79±8.53） g/L]明显低于对照组[（33.66±9.63） g/L]，差异有统计学意义（P＝0.011）。重症组纤维蛋白降解产物[（10.98±1.32） ng/L]明显高于对照组[（3.61±0.98） ng/L]，差异有统计学意义（P＝0.002）。重症组D-二聚体[（2.68±0.56） mg/L]明显高于对照组[（0.42±0.12） mg/L]，差异有统计学意义（P＝0.001）。重症组降钙素原[（1.63±0.32） mg/L]明显高于照组[（0.13±0.21） mg/L]，差异有统计学意义（P＝0.015）。多因素Logistic回归分析结果显示，误吸、血清白蛋白、D-二聚体为老年重症社区获得性肺炎的独立危险因素（OR值分别为1.782、1.208、1.356，P均〈0.05）。结论误吸、低蛋白血症、D-二聚体是老年重症社区获得性肺炎的危险因素。D-二聚体可作为老年重症社区获得性肺炎患者评估病情严重程度的指标。

Objective To evaluate the risk clinic factors of severe community-acquired pneumonia in older adults, and to provide examples for its clinic application. Methods Sixty-four case patients who were admitted for a diagnosis of severe community-acquired pneumonia in older adults in Beijing Haidian Hospital from January 2013 to July 2015 were selected as observation group.One hundred cases patients also admitted for a diagnosis of community-acquired pneumonia were selected as control group.Within 24 h of admission, the clinical data were collected, medical history were collected, and the serum biochemistry, coagulation index fibrin degradation product, D-dimer and inflammatory factor procalcitonin were detected.The data were analyzed by univariate analysis, and logistic regression analysis was used to analyze the variables with significant difference in single factor analysis.Results Single factor analysis showed that the percentage of severe pneumonia with central nervous system disorders, severe pneumonia with aspiration, severe pneumonia with two or more comorbidities, aspiration and severe pneumonia with bedridden patient in observation group were obviously higher than the control group, the difference between two groups have remarkable statistical significance（（82.21%（53/64） vs.32%（32/100）, 60.93%（39/64） vs.1%（1/100）, （84.37%, 54/64） vs.54%（54/100）, 90.62%（58/64） vs.28%（28/100）, 59.37%（38/64） vs.11%（11/100）; P〈0.01 or P〈0.05）. The mortality of observation group was higher than the control group, the difference between two groups have remarkable statistical significance（56.62%（36/64）] vs.3%（3/100）, P=0.001）. Albumin of severe pneumonia was obviously lower than the control group, the difference between two groups have remarkable statistical significance（（27.79±8.53） g/L vs.（33.66±9.63） g/L, P=0.011）. Fibrin degradation product of severe pneumonia was obviously lower than the control group, the difference between two groups have remarkable statistical significance（（10.98±1.32） ng/L vs.（3.61±0.98） ng/L, P=0.002）. D- dimer of severe pneumonia was obviously higher than the control group, the difference between two groups have remarkable statistical significance（（2.68±0.56） mg/L vs.（0.42±0.12） mg/L, P=0.001）. Procalcitonin of severe pneumonia was obviously higher than the control group, the difference between two groups have remarkable statistical significance （（1.63±0.32） ng/L vs.（0.13±0.21） ng/L, P=0.015）. The result of multiple factors logistic regression analysis showed the aspiration, hypoproteinemia, D-dimer were severe community-acquired pneumonia in older adults＇s independent risks（OR=1.782, 1.208, 1.356, P〈0.05）.Conclusion Aspiration, hypoproteinemia, D-dimer are the factors of risking suffering severe community-acquired pneumonia in older adults.D-dimer could be the detection index of severe community-acquired pneumonia in older adults.