肝素结合蛋白、降钙素原分别联合APACHEⅡ评分对呼吸机相关性肺炎的诊断价值

Diagnostic value of HBP,PCT combined with APACHEⅡscore respectively in ventilator-associated pneumonia

目的探讨肝素结合蛋白(HBP)、降钙素原(PCT)分别联合急性生理和慢性健康评分Ⅱ(APACHEⅡ)在呼吸机相关性肺炎(VAP)中的诊断价值。方法选取2015年1月至2017年1月在郑州大学第一附属医院收治的气管插管或气管切开接受有创机械通气治疗的患者160例,根据病情分为VAP组68例和非VAP组92例,VAP组根据抗感染治疗1周后的效果分为改善组和恶化组;以同期40例社区获得性肺炎(CAP)患者(CAP组)及30名健康志愿者(健康对照组)作为对照。获取不同时间点的血浆,分别采用酶联免疫法(ELISA)及电化学发光法(ECLIA)测定血浆中HBP及PCT水平,通过APACHEⅡ评分量化患者病情严重程度。分析各组3个指标及HBP、PCT分别联合APACHEⅡ评分的差异及三者诊断VAP的相关性。绘制受试者工作特征(ROC)曲线分析其对VAP的诊断价值。结果共纳入VAP组68例、非VAP组92例、CAP组40例、健康对照组30名。VAP组及非VAP组机械通气前HBP、PCT、APACHEⅡ评分差异均无统计学意义(均P>0.05)。VAP组确诊时的HBP、PCT、APACHEⅡ评分分别为(41.4±21.3)μg/L、(0.355±0.254)μg/L、(13.4±2.5)分,显著高于VAP组机械通气时的(7.3±2.7)μg/L、(0.080±0.038)μg/L、(8.4±2.0)分(均P<0.001);非VAP组机械通气前后HBP、PCT、APACHEⅡ差异均无统计学意义(均P>0.05)。VAP组的HBP与PCT及APACHEⅡ评分均呈正相关(r=0.82、0.68,均P<0.001)。VAP恶化组抗感染治疗1周后的HBP、PCT和APACHEⅡ均显著高于该组VAP确诊时(均P<0.001),且其三者在VAP确诊时及抗感染治疗1周后均显著高于改善组(均P<0.001)。HBP+APACHEⅡ评分、PCT+APACHEⅡ评分诊断VAP的曲线下面积分别为0.98、0.95,HBP+APACHEⅡ评分在诊断VAP时的敏感度低于PCT+APACHEⅡ评分(94.1%比95.6%),特异度高于后者(92.4%比82.6%)。结论HBP+APACHEⅡ评分对早期诊断VAP的诊断价值优于PCT+APACHEⅡ。

Objective To evaluate the diagnostic value of the heparin-binding protein(HBP),procalcitonin(PCT)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score in ventilator-associated pneμmonia(VAP).Methods A total of 160 patients who required tracheotomy or intubation and assisted breathing with invasive mechanical ventilator from the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 was included in this prospective study,and divided into VAP group and no-VAP group based on if VAP happened or not;the VAP group was further divided into deterioration group and improvement group based on the curative effect after anti-infective treatment for 1 week.A total of 40 community acquired pneumonia(CAP)patients and 30 healthy volunteers were also included as control groups.The levels of HBP and PCT in blood of the subjects were tested with enzyme-linked immuno sorbent assay(ELISA)and chemiluminescence immunoassay(ECLIA)respectively,APACHEⅡscore was utilized to assess the severity of illness.The difference of HBP,PCT levels and APACHEⅡscore among the groups were analyzed.Receiver operating characteristic(ROC)curve was utilized to analyze the diagnostic value of HBP,PCT,APACHEⅡscore in VAP.Results A total of 230 subjects participated in this study,including 68 VAP patients,92 non-VAP patients,40 CAP patients and 30 healthy volunteers.Before administration of mechanical ventilation,there were no statistically significant differences in HBP,PCT and APACHEⅡscore between VAP group and non-VAP group(all P>0.05).The levels of HBP,PCT and APACHEⅡscore were(41.4±21.3)μg/L,(0.355±0.254)μg/L,(13.4±2.5)respectively when the VAP was diagnosed,which were higher than those within the first 12 h of mechanical ventilation(7.3±2.7)μg/L,(0.080±0.038)μg/L,(8.4±2.0),all P<0.001).The HBP,PCT and APACHEⅡscore had no significant difference between within the first 12 h of mechanical ventilation and after mechanical ventilation in non-VAP group(all P>0.05).The levels of HBP was positively correlated with PCT and APACHEⅡscore(r=0.82,0.68,all P<0.001).In deterioration group,the HBP,PCT and APACHEⅡscore after 1 week of anti-infective treatment were higher than those when the VAP was diagnosed(all P<0.001).No matter it is when the VAP was diagnosed or after anti-infective treatment for 1 week,the levels of HBP,PCT and APACHEⅡscore in deterioration group were higher than those in the improvement group(all P<0.001).The area under curve(AUC)of HBP+APACHEⅡscore,PCT+APACHEⅡscore for VAP diagnosis was 0.98,0.95 respectively.The sensitivity of HBP+APACHEⅡscore in the diagnosis of VAP was lower than PCT+APACHEⅡscore(94.1%vs 95.6%),and the specificity was higher(92.4%vs 82.6%).Conclusion The diagnostic value of HBP+APACHEⅡscore for early VAP is superior to PCT+APACHEⅡscore.