CPIS联合炎症介质水平在重症肺炎医院感染诊断中的价值与效能评价

The value and efficacy of CPIS combined with inflammatory mediators in the diagnosis of severe pneumonia nosocomial infection

目的探讨肺部感染评分(CPIS)联合炎症介质在重症肺炎医院感染诊断中的应用价值及效能。方法收集2015年12月-2018年3月于乐清市人民医院治疗的重症肺炎患者59例为A组,其中脓毒症者33例、重症脓毒症者26例,同期收集普通肺炎患者32例为B组,健康体检者85例为C组。观察和记录A组、B组患者感染时(T0)、感染24 h(T1)、感染48 h(T2)、感染72 h(T3)和感染控制后(T4)及C组体检者白细胞计数(WBC)、降钙素原(PCT)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平和CPIS评分。绘制受试者工作特征(ROC)曲线。比较曲线下面积(AUC)大小,明确诊断灵敏度、特异性。结果T0时A组患者WBC、PCT、IL-10、TNF-α及CPIS评分分别为(22.10±4.12)×10^9/L、(12.95±1.85)ng/ml、(367.40±76.00)ng/L、(298.00±87.50)pg/ml及(7.60±2.30)分高于B组及C组(P<0.05)。T1、T2、T3、T4时WBC、PCT、IL-10、TNF-α水平及CPIS评分,A组、B组均先升高、后下降,但A组上述指标水平及评分始终高于B组,差异均有统计学意义(P<0.05)。重症脓毒症者WBC、PCT、IL-10、TNF-α水平及CPIS评分分别为(26.50±2.40)×10^9/L、(15.30±2.38)ng/ml、(417.50±28.40)ng/L、(325.00±48.00)pg/ml、(10.40±1.20)分均高于脓毒症者(P<0.05)。IL-10、TNF-α、CPIS评分及三者联合AUC为0.787、0.809、0.820、0.851,三者联合诊断的灵敏度及特异度分别为0.780和0.812,其中特异度较单项检测明显提高。结论对于重症肺炎早期诊断,CPIS评分、IL-10、TNF-α水平检测相对传统感染指标价值更为显著、效能尤为突出;且三者联合同步进行,相互补充,能为临床提供更加迅捷、全面的信息,有助于重症肺炎医院感染早期诊断。

OBJECTIVE To study the clinical value and efficacy of clinical pulmonary infection score(CPIS)combined with inflammatory mediators in the diagnosis of severe pneumonia nosocomial infection.METHODS Totally 59 cases of severe pneumonia in our hospital from Dec.2015 to Mar.2018 were collected as group A,including 33 cases of sepsis and 26 cases of severe sepsis.32 cases of common pneumonia in the same period were selected as group B,and 85 cases of healthy people as group C.At time of infection(T0),24 h after infection(T1),48 h after infection(T2),72 h after infection(T3)and after the infection was controlled(T4),the leukocyte count(WBC),levels of procalcitonin(PCT),interleukin-10,tumor necrosis factor-α,and CPIS score in group A,B and C were observed and recorded.The receiver operating characteristic curve(ROC curve)was drawn.The area under the curve(AUC)was compared to determine the sensitivity and specificity of the diagnosis.RESULTS At T0,the WBC,PCT,IL-10,TNF-αand CPIS score of group A were(22.10±4.12)×10^9/L,(12.95±1.85)ng/ml,(367.40±76.00)ng/L,(298.00±87.50)pg/ml and(7.60±2.30)points,significantly higher than those of group B and C(P<0.05).The levels of WBC,PCT,IL-10,TNF-αand CPIS at T1,T2,T3 and T4 increased first and then decreased in group A and group B,but the above indicators in group A were always higher than those in group B.The differences were significant(P<0.05).The levels of WBC,PCT,IL-10,TNF-αand CPIS score in patients with severe sepsis were(26.50±2.40)×10^9/L,(15.30±2.38)ng/ml,(417.50±28.40)ng/L,(325.00±48.00)pg/ml,(10.40±1.20)points,higher than those with sepsis(P<0.05).The AUC of IL-10,TNF-α,CPIS score and their combination were 0.787,0.809,0.820 and 0.851.The sensitivity and specificity of the combination of the three indicators in diagnosis were 0.780 and 0.812,respectively,and the specificity was significantly improved compared with that of the single tests.CONCLUSION For the early diagnosis of severe pneumonia,the detection of CPIS score,IL-10 and TNF-αlevels is more significant and more effective than traditional infection indicators;when the three indicators are combined and synchronized,more rapid and comprehensive information could be provided,which would help the early diagnosis of severe pneumonia nosocomial infection.