血清CHE、LDH及APACHEⅡ评分与重症肺炎患者病情变化的关系及其在临床预后中的价值

Relationship between Serum CHE,LDH and APACHEⅡ Scores and the Changes of Severe Pneumonia and Their Value in Clinical Prognosis

目的:探讨血清胆碱酯酶(CHE)和乳酸脱氢酶(LDH)水平、急性生理学及慢性健康状况评分(APACHEⅡ)与重症肺炎患者病情变化的关系以及对患者预后评估的价值。方法:回顾性分析本院呼吸与危重症医学科在2019年7月至2022年6月期间收治的88例重症肺炎患者、96例普通肺炎患者和同期来院体检的100名健康者的临床资料。根据是否死亡将重症肺炎患者分为存活组(58例)和死亡组(30例)。采用丁酰硫代胆碱底物法检测血清CHE水平,采用乳酸底物法检测血清LDH水平,测量入院时APACHEⅡ评分并进行统计分析。采用受试者工作特征(ROC)曲线分析患者血清CHE、LDH水平和APACHEⅡ评分对死亡的预测价值。结果:(1)重症肺炎组血清CHE水平显著低于普通肺炎组和对照组,LDH水平显著高于普通肺炎组和对照组,APACHEⅡ评分显著高于普通肺炎组(P<0.05)。普通肺炎组血清CHE水平与对照组比较无差异(P>0.05),LDH水平显著高于对照组(P<0.05)。(2)存活组患者血清CHE水平随时间显著增加,LDH水平和APACHEⅡ评分显著降低;死亡组患者血清CHE水平随时间显著降低,LDH水平和APACHEⅡ评分显著增加(P<0.05)。死亡组患者不同时间血清CHE水平显著低于存活组,LDH水平和APACHEⅡ评分显著高于存活组(P<0.05)。(3)重症肺炎患者血清CHE与LDH和APACHEⅡ评分间均呈显著负相关,LDH和APACHEⅡ评分呈显著正相关(P<0.05)。(4)ROC曲线结果表明:入院第1d血清CHE预测重症肺炎患者死亡的AUC为0.790(95%CI:0.688~0.891),最佳诊断cutoff值为≤3.3 kU/L,对应的敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为66.67%、77.59%、44.26%、60.61%和81.82%;血清LDH预测重症肺炎患者死亡的AUC为0.924(95%CI:0.862~0.985),最佳诊断cutoff值为≥382 U/L,对应的敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为93.33%、79.31%、72.64%、70.00%和95.83%。APACHEⅡ评分预测重症肺炎患者死亡的AUC为0.966(95%CI:0.931~1.000),最佳诊断cutoff值为≥23.5分,对应的敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为83.33%、100.00%、83.33%、100.00%和92.06%。结论:入院第1 d时血清CHE、LDH和APACHEⅡ评分都能有效预测重症肺炎发生死亡的风险,LDH和APACHEⅡ评分预测效能更高,且LDH操作更加简单。

Objective:To investigate the relationship between serum cholinesterase(CHE)and lactate dehydrogenase(LDH)levels,acute physiology and chronic health status scores(APACHEⅡ)and changes in the condition of patients with severe pneumonia,and the value of prognostic assessment of patients.Methods:The clinical data of 88 patients with severe pneumonia,96 patients with common pneumonia,and 100 healthy individuals who came to the hospital for physical examination during the same period were retrospectively analyzed in the Department of Respiratory and Critical Care Medicine of our hospital between July 2019 and June 2022.Patients with severe pneumonia were divided into a survival group(58 cases)and a death group(30 cases)according to whether they died or not.Serum CHE levels were measured by the butyrylthiocholine substrate method and serum LDH levels were measured by the lactate substrate method,and APACHE II scores at admission were measured and statistically analyzed.The predictive value of patients'serum CHE and LDH levels and APACHE II scores on death was analyzed using subject operating characteristic(ROC)curves.Results:(1)The serum CHE level in the severe pneumonia group was lower than that in the common pneumonia group and the control group,and the LDH level was higher than that in the common pneumonia group and the control group,and the APACHEⅡscore was higher than that in the common pneumonia group(P<0.05).There was no difference in serum CHE levels in the common pneumonia group compared with the control group(P>0.05),and LDH levels were higher than those in the control group(P<0.05).(2)In the surviving group,serum CHE levels increased significantly over time,LDH levels and APACHE II scores decreased;in the death group,serum CHE levels decreased over time,and LDH levels and APACHE II scores increased(P<0.05).In the death group,serum CHE levels were lower than those in the survivor group at different times,and LDH levels,APACHE II scores were higher than those in the survivor group(P<0.05).(3)There was a negative correlation between serum CHE and both LDH and APACHE II scores,and a positive correlation between LDH and APACHE II scores in patients with severe pneumonia(P<0.05).(4)The AUC of serum CHE at the 1st d of admission to predict death in patients with severe pneumonia was 0.790(95%CI:0.688-0.891),with an optimal diagnostic cutoff value of≤3.3 kU/L,corresponding to a sensitivity,specificity,Jorden index,positive predictive value and negative predictive value of 66.67%,77.59%,44.26%,60.61%and 81.82%.The AUC of serum LDH for predicting death in patients with severe pneumonia was 0.924(95%CI:0.862-0.985),with an optimal diagnostic cutoff value of≥382 U/L,corresponding to a sensitivity,specificity,Jorden index,positive predictive value and negative predictive value of 93.33%,79.31%,72.64%,70.00%and 95.83%,respectively.The AUC of APACHE II score to predict death in patients with severe pneumonia was 0.966(95%CI:0.931 to 1.000),with an optimal diagnostic cutoff value of≥23.5 points,corresponding to sensitivity,specificity,Jorden index,positive predictive value and negative predictive value of 83.33%,100.00%,83.33%,100.00%and 92.06%.Conclusions:Serum CHE,LDH and APACHEⅡscores on the first day of admission can effectively predict the risk of death from severe pneumonia,and LDH and APACHEⅡscores have higher predictive efficiency,and measurement of LDH is more convenient.