血清降钙素原、动脉血乳酸联合肺炎严重指数在重症社区获得性肺炎患者病情、预后判断中的作用

Role of serum procalcitonin, arterial blood lactic acid combined with pneumonia severity index in the disease and prognosis diagnosis of severe community acquired pneumonia patients

目的探讨血清降钙素原(PCT)、动脉血乳酸联合肺炎严重指数(PSI)在重症社区获得性肺炎(SCAP)患者病情、预后判断中的作用。方法选取2016年1月~2018年12月于长江大学附属仙桃市第一人民医院重症医学科住院治疗的72例SCAP患者作为研究对象,根据PSI评分将其分为低危组(27例,≤90分)、中危组(25例,91~130分)、高危组(20例,>130分);根据28 d预后将其分为死亡组(17例)、存活组(55例)。分别比较各组患者入院时血清PCT、动脉血乳酸水平及PSI,分析PCT、动脉血乳酸与PSI评分的相关性关系,采用受试者工作特征(ROC)曲线分析PCT、动脉血乳酸、PSI单一指标及联合判断SCAP患者预后的临床价值。结果随着危险程度加重,血清PCT、动脉血乳酸水平及PSI评分均升高(P<0.05),且不同危险组患者的血清PCT、动脉血乳酸水平及PSI评分比较,差异有统计学意义(P<0.05)。Spearman分析结果显示,PCT、动脉血乳酸与PSI评分均成正相关(r=0.628,r=0.654,P<0.05)。死亡组患者的血清PCT、动脉血乳酸水平及PSI评分均高于存活组,差异有统计学意义(P<0.05)。血清PCT、动脉血乳酸、PSI评分联合判断SCAP患者预后的敏感度、曲线下面积(AUC)均高于单一指标。结论血清PCT、动脉血乳酸、PSI均可用于SCAP患者病情判断,且联合应用于SCAP患者预后判断的临床价值优于单一指标,值得广泛应用。

Objective To investigate the role of serum procalcitonin(PCT),arterial lactic acid combined with pneumonia severity index(PSI)in the disease and prognosis diagnosis of severe community acquired pneumonia(SCAP)patients.Methods Seventy-two patients with SCAP who hospitalized in the Critical Care Medicine Department of Xiantao First People′s Hospital Affiliated to Yangtze University from January 2016 to December 2018 were selected as research objects,and they were divided into low-risk group(27 cases,≤90 points),medium-risk group(25 cases,91-130 points),high-risk group(20 cases,>130 points)according to the PSI score.They were divided into death group(17 cases)and survival group(55 cases)according to the prognosis of 28 days.The levels of serum PCT,arterial blood lactic acid and PSI at admission were compared in each group,and the correlation between PCT,arterial blood lactic acid and PSI score was analyzed.The receiver operating characteristics(ROC)curve was used to analyze the clinical value of single indicators of PCT,arterial blood lactic acid and PSI and the combined prognosis of SCAP patients.Results With the increase of risk,the levels of serum PCT,arterial blood lactic acid and PSI score increased(P<0.05),and there were significant differences in serum PCT,arterial lactate acid levels and PSI scores among patients in different risk groups(P<0.05).Spearman analysis results showed that PCT and arterial blood lactic acid were positively correlated with PSI score(r=0.628,r=0.654,P<0.05).The levels of serum PCT,arterial blood lactic acid and PSI score in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).The sensitivity and area under the curve(AUC)of serum PCT,arterial blood lactic acid and PSI score to judge the prognosis of SCAP patients were higher than those of single index.Conclusion Serum PCT,arterial blood lactic acid and PSI all can be used to judge the condition of SCAP patients,and the clinical value of the combined application in predicting the prognosis of SCAP patients is better than the single index,which is worthy of extensive application.