颈髓损伤术后医院获得性肺炎影响因素及PCT与CRP的诊断价值

Influencing factors for nosocomial pneumonia after cervical spinal cord injury and diagnostic value of PCT,CRP

目的探究颈髓损伤术后医院获得性肺炎(HAP)的影响因素,分析降钙素原(PCT)、C-反应蛋白(CRP)的诊断价值。方法回顾性分析2017年2月-2019年2月河北医科大学第三医院239例行颈髓损伤术患者的病例资料,根据有无发生HAP进行分组,分为HAP感染组(61例)和非HAP感染组(178例)。单因素及多因素Logistic回归分析颈髓损伤术后HAP的感染因素,观察患者PCT、CRP水平的诊断价值。结果行颈髓损伤术后HAP发生率为25.52%(61/239);两组颈髓损伤术后患者的年龄、颈髓损伤节段、日本骨科协会(JOA)评分、住院时间,差异有统计学意义(P<0.05);Logistic回归分析结果,颈髓损伤节段(OR=1.236)、JOA评分(OR=3.214)、住院时间(OR=1.317)为颈髓损伤术后HAP的影响因素;术后,HAP感染组患者PCT、CRP水平高于非HAP感染组(P<0.05);PCT曲线下面积(AUC)大于CRP,特异度高于CRP(P<0.05)。结论颈髓损伤术后患者HAP发生率较高,颈髓损伤节段、JOA评分、住院时间为颈髓损伤术后HAP的影响因素,同时PCT可作为HAP的首选诊断指标,CRP可作为辅助诊断指标,为临床预防诊断HAP提供参考依据。

OBJECTIVE To investigate the influencing factors for hospital acquired pneumonia(HAP)after cervical spinal cord injury,and to analyze the diagnostic value of procalcitonin(PCT),C-reactive protein(CRP).METHODS The clinical data of 239 patients with cervical spinal cord injury were retrospectively analyzed,from Feb.2017 to Feb.2019.Also,they were divided into Hospital acquired pneumonia HAP infection group(61 cases)and non-HAP infection group(178 cases)according to the occurrence of HAP.Univariate and multivariate unconditional logistic regression were used to analyze the infection factors of hospital acquired pneumonia after cervical spinal cord injury.The diagnostic value of PCT,CRP was observed.RESULTS The incidence of HAP after cervical spinal cord injury was 25.52%;differences in the age,cervical spinal cord injury segment,Japanese orthopaedic association(JOA)score,and length of hospital stay between the two groups of patients after cervical spinal cord injury were significantly different(P<0.05);Logistic regression analysis shows that the cervical spinal cord injury segment(OR=1.236),JOA score(OR=3.214),and length of stay(OR=1.317)were HAP after cervical spinal cord injury.The PCT and CRP of the HAP infection group were significantly higher than those of the non-HAP infection group(P<0.05);PCT The area under the curve(AUC)is significantly greater than CRP(P<0.05);the optimal cut-off point of PCT index was 0.60 ng/ml,and the optimal cut-off point of CRP index was 50 mg/L,and the specificity of PCT was significantly higher than CRP(P<0.05).CONCLUSION This study found that the incidence of HAP was higher in patients with cervical spinal cord injury after operation.Cervical spinal cord injury segment,JOA score,mechanical ventilation,tracheotomy and hospitalization time were independent influencing factors of HAP after operation.At same time,PCT could be the first diagnostic index of HAP,and the total number of CRP could be used as auxiliary diagnostic index,providing reference for clinical prevention and diagnosis of HAP.