老年社区获得性肺炎严重程度与LDH及中医证型的相关性研究

On the Relationship between LDH,TCM Syndrome Type Distribution and the Severity of Community-acquired Pneumonia in the Elderly

目的观察乳酸脱氢酶(LDH)水平在老年社区获得性肺炎(CAP)患者的变化,中医证型在老年CAP患者的分布特点,并探讨两者对老年CAP严重程度的诊断价值。方法收集老年CAP患者共223例。提取患者资料,根据CURB-65评分将患者分为轻型和重型两组,比较两组患者之间各项指标的差异;使用Logistic回归分析、ROC曲线分析LDH、中医证型与病情严重程度之间的关系,以及LDH在诊断重型CAP的最佳截断值。结果相较于轻型组,重型组有更高的LDH水平(P<0.05);两组患者在是否患有冠心病、中医证型分布方面存在差异(P<0.05);不同中医证型的LDH水平具有差异性(P<0.05);Logistic回归分析发现,LDH、是否患有冠心病、中医证型分型与患者病情严重程度相关;LDH判断与是否为老年重型CAP的ROC曲线分析显示,曲线下面积为[0.98,95%CI(0.969~0.997),P<0.001],截点为175.9 U/L,此截点处敏感度为93.2%,特异性为2.8%,Youden指数为0.904。结论LDH、中医证型分型与老年CAP严重程度相关,两者相结合可以作为评估患者病情的重要指标之一。

Objective:To investigate the changes of lactate dehydrogenase(LDH)levels and the distribution characteristics of TCM syndrome types in elderly patients with community-acquired pneumonia(CAP),and their diagnostic value in determining the severity of CAP in elderly patients.Methods:Medical records of 223 elderly patients with CAP were collected.Patients were divided into mild and severe groups according to their CURB-65scores.ROC curve and logistic regression analysis were used to analyze the relationship between LDH,TCM syndrome types and the severity of CAP,and determine the best cut-off value of LDH for diagnosis of severe CAP.Results:Compared to the mild CAP group,the severe CAP group had higher levels of LDH(P<0.05).Between the two groups,there were statistically significant differences in the proportion of patients with CHD,and in their TCM syndrome type distributions(P<0.05).There were statistically significant differences in LDH levels between different TCM syndrome types(P<0.05).Logistic regression analysis showed that the LDH levels,coronary heart disease,and TCM syndrome types were related to the severity of the patient′s condition.ROC curve analysis showed that the area under the curve was[0.98,95%CI(0.969~0.997),P<0.001].The cut-off point was 175.9 U/L,with a sensitivity of 93.2%,specificity of 2.8%,and Youden index of 0.904.Conclusion:LDH levels and TCM syndrome types are correlated with the severity of CAP in the elderly,and they can be used in combination as one of the important indicators in evaluating the patient′s condition.