PSI和CURB-65评分对艾滋病和非艾滋病社区获得性肺炎患者预后的临床评估价值

Clinical value of PSI and CURB-65 scores in assessing prognosis of community-acquired pneumonia in AIDS and non-AIDS patients

目的探讨肺炎严重指数(PSI)和英国胸科协会改良肺炎评分(CURB-65)对艾滋病和非艾滋病患者社区获得性肺炎(CAP)预后的临床评估价值。方法回顾性分析2015年10月—2018年8月柳州市人民医院288例艾滋病CAP患者(A组)和201例非艾滋病CAP患者(B组)的临床资料。记录所有患者入院后24 h内的相关资料,根据临床预后将A组患者分为好转组和恶化组,将B组患者同样也分为好转组和恶化组。计算患者PSI和CURB-65评分,绘制受试者工作特征(ROC)曲线分析这两种评分系统的预测能力。结果好转组和恶化组的PSI和CURB-65评分比较,差异均有统计学意义(P<0.05);艾滋病CAP患者PSI和CURB-65评分的ROC曲线下面积(AUC)分别为0.672(95%CI:0.599,0.744)、0.603(95%CI:0.522,0.684),差异无统计学意义(P>0.05)。非艾滋病CAP患者PSI和CURB-65评分的AUC分别为0.863(95%CI:0.775,0.950)、0.848(95%CI:0.777,0.920),差异无统计学意义(P>0.05)。结论PSI和CURB-65评分系统能准确预测非艾滋病CAP患者的预后状况,适于临床推广应用;对于艾滋病CAP患者,单独应用这两种评分的预测效果均不佳。

Objective To study the clinical value of PSI and CURB-65 scores in assessing the prognosis of community-acquired pneumonia(CAP)in AIDS and Non-AIDS patients.Methods Totally 288 CAP patients with AIDS(group A)and 201 CAP patients with Non-AIDS(group B)were retrospectively analyzed.Relevant clinical data within 24 hours after admission were recorded.According to the prognosis,the patients were divided into improvement group and deterioration group.The PSI score and CRUB-65 scores were calculated according to the clinical data.The predictive ability of the two scoring systems was analyzed by receiver operator characteristic(ROC)curve.Results There were significant differences in PSI and CRUB-65 scores between deterioration group and improvement group in group A and B(P<0.05).In group B,the AUC of the PSI and CURB-65 scores was 0.863(95%CI:0.775,0.950)and 0.848(95%CI:0.777,0.920).There was no significant difference between PSI and CURB-65 score(P>0.05).In group A,the area under curve(AUC)of the PSI and CURB-65 scores were 0.672(95%CI:0.599,0.744)and 0.603(95%CI:0.522,0.684).There was no significant difference between PSI and CURB-65 score(P>0.05).Conclusion The PSI and CURB-65 score systems can more accurately predict the prognosis of CAP patients with non-AIDS,which is suitable for clinical application.However,these two score systems are not suitable for the community-acquired pneumonia patients with AIDS.