G试验水平对艾滋病合并肺孢子菌肺炎机械通气患者脱机结局的预测价值

Predictive value of blood(1,3)-β-D-glucan for outcome of ventilator weaning in patients with AIDS and pneumocystis jirovecii pneumonia

目的探讨G试验能否预测艾滋病合并肺孢子菌肺炎(PCP)机械通气患者的撤机。方法回顾性分析北京佑安医院感染科监护病房2010年5月至2017年5月收治的艾滋病合并重症PCP且行机械通气治疗患者的临床资料,根据患者脱机成功与否将患者分为两组,比较两组患者G试验水平。结果共入选49例患者,脱机成功组9例,失败组40例。两组患者基线资料比较结果显示,白蛋白、CD4计数、G试验水平差异均有统计学意义(P均<0.05)。成功组G试验水平显著低于失败组,分别为331.0 ng/L(299.0~488.7 ng/L)和267.0 ng/L(236.0~294.5 ng/L)。多因素分析结果显示,血清G试验水平是影响艾滋病合并重度PCP患者能够脱机与否的独立危险因素(OR=0.978,95%CI:0.959~0.998,P=0.032)。结论 G试验可以作为一项脱机结局预测指标,用来预测艾滋病合并PCP患者撤机预后。

Objective To investigate the possibility that blood（1,3）-β-D-glucan can predict the outcome of ventilator weaning in patients with AIDS and pneumocystis jirovecii pneumonia（PCP）. Methods The AIDS patients with PCP who received mechanical ventilation in intensive care unit（ICU） of Beijing You＇an Hospital from May 2010 to May 2017 were retrospectively analyzed. They were divided into success group and failure group according to the outcome of the first weaning. And the difference of blood（1,3）-β-D-glucan between the two groups was analyzed. Results Forty-nine patients were enrolled in this study,with 9 patients in the success group and 40 patients in the failure group. The baseline information between the two groups were compared. The results showed that the levels of albumin, CD4 count and blood（1,3）-β-D-glucan were statistically different（P〈0.05）. The PCT level of and the success group was lower than that in the failure group [331.0 ng/L（299.0~488.7 ng/L） vs. 267.0 ng/L（236.0~294.5 ng/L）]. Multivariate analysis showed that blood（1,3）-β-D-glucan was an independent risk factor for ventilator weaning for AIDS patients with severe PCP. Conclusion Blood（1,3）-β-D-glucan level can be used as a predictive index for ventilator weaning in AIDS patients with PCP.