急诊社区获得性肺炎患者中类肺炎性胸腔积液的危险因素分析

Analysis of Risk Factors for Parapneumonic Pleural Effusion in Patients with Community Acquired Pneumonia in the Emergency Department

目的探讨急诊社区获得性肺炎(CAP)患者中类肺炎性胸腔积液(PPE)的常见危险因素。方法回顾性分析2014年1月至2016年11月于中国医科大学附属第一医院急诊科就诊的276例CAP患者的临床资料,根据是否存在PPE将276例患者分为PPE组和无PPE组(NPPE组),收集2组患者的临床资料,包括年龄、性别、生命体征、初诊的实验室检查指标、住院时间、28 d患者死亡率,计算2组患者的CURB-65评分,对各项因素进行单因素分析,单因素分析有显著意义的变量行二项分类logistic回归分析。结果 276例CAP患者中PPE组46例,NPPE组230例。患者是否存在PPE与年龄、性别、白细胞计数、血小板计数、丙氨酸氨基转移酶无关(P>0.05),与低钠血症、低蛋白血症、降钙素原、CURB-65评分相关(P<0.05)。二项分类logistic回归分析显示,低钠血症、低蛋白血症、降钙素原是PPE发生的独立危险因素。PPE组患者入住急诊ICU的比例更高(分别为22.1%和7.5%,P<0.05),住院时间更长(中位时间分别为16和5 d,P<0.05),但2组患者28 d死亡率的差异无统计学意义(P>0.05)。结论低钠血症、低蛋白血症、降钙素原与PPE发生存在正相关,临床上应给予重视,积极调整治疗方案,改善患者预后。

Objective To evaluate the risk factors for parapnettmonic pleural effusion （PPE） in patients with commtmity acquired pneumonia （CAP） in the emergency department. Methods A total of 276 patients with CAP were enrolled. Based on the presence of PPE, they were divided into a PPE group and a non-PPE （NPPE） group. Age, gender, vital signs, initial laboratory results, length of stay, 28-day mortality, and CURB- 65 score were collected. A univariate analysis was performed, and logistic regression analysis was used to determine statistical significance. Results There were 46 patients in the PPE group and 230 in the NPPE group. The univariate analysis indicated that differences in age, gender, white blood cell count, platelet count, and serum alanine aminotransferase were not statistically significant （P 〉 0.05 ） between the two groups. The differences in hyponatremia, hypoproteinemia, serum procalcitonin levels, and CURB-65 scores were statistically significant （P 〈 0.05 ）. The logistic regression analysis revealed that hyponatremia, hypoproteinemia, and serum procalcitonin level were independent risk factors. The patients in the PPE group were more likely to be admitted （22.1% vs 7.5%, P 〈 0.05 ） and had longer hospital stays （median 16 days vs 5 days, P 〈 0.05 ） than those in the NPPE group. However, there was no difference in 28-day mortality between PPE and NPPE groups （ 8.6% vs 8.3%, P 〉 0.05 ）. Conclusion CAP patients with PPE in the emergency department were more likely to be admitted and had longer hospital stays, Hyponatremia, hypoproteinemia, and serum procalcitonin were independent risk factors for pleural effusion. Therefore, to decrease morbidity, as well as economic burden, we should pay more attention and provide earlier treatment to patients with PPE.