慢性意识障碍患者合并肺部感染的影响因素

Influencing Factors of Prolonged Disorders of Consciousness Patients Combined with Pulmonary Infection

目的探讨慢性意识障碍(pDOC)患者合并肺部感染的影响因素。方法回顾性分析2019年1月至2021年4月北京博爱医院重症医学科收治的111例pDOC患者的临床资料,根据临床肺部感染评分(CPIS)将患者分为单纯意识障碍组(CPIS≤6分,75例)和合并肺炎组(CPIS>6分,36例)。收集患者基本信息、实验室检查指标、胸部CT、CPIS等临床资料。比较两组一般资料、血清学指标[白细胞计数、C反应蛋白(CRP)、降钙素原(PCT)、高敏CRP(hs-CRP)、血清白蛋白、尿素氮、血肌酐、血乳酸、D-二聚体、N端脑钠肽前体(NT-proBNP)],分析临床血清学指标与CPIS的相关性,采用Logistic回归分析pDOC患者合并肺部感染的影响因素,绘制受试者工作特征曲线(ROC曲线)分析临床血清学指标对pDOC患者合并肺炎的预测价值。结果两组一般资料比较差异无统计学意义(P>0.05)。合并肺炎组患者的体温、白细胞计数、CRP、PCT、hs-CRP、血乳酸、尿素氮、D-二聚体均高于单纯意识障碍组[37.1(36.8,37.9)℃比37.0(36.5,37.4)℃、12.8(8.8,14.3)×10^(9)/L比8.8(8.3,11.0)×10^(9)/L、37(15,103)mg/L比19(10,54)mg/L、0.53(0.15,3.68)μg/L比0.26(0.14,0.61)μg/L、42(17,103)mg/L比20(9,46)mg/L、1.60(1.35,1.97)mmol/L比1.29(0.96,1.71)mmol/L、8.3(5.3,14.6)mmol/L比6.9(4.4,8.7)mmol/L、2.76(1.34,6.00)mg/L FEU比1.83(0.85,3.14)mg/L FEU](P<0.05或P<0.01),而血清白蛋白水平低于单纯意识障碍组[33.7(30.8,36.7)g/L比35.8(33.5,38.4)g/L](P<0.01)。临床血清学指标与CPIS的相关性分析结果显示,体温、白细胞计数、CRP、PCT、尿素氮、hs-CRP、血乳酸、D-二聚体均与CPIS呈正相关,而血清白蛋白与CPIS呈负相关(P<0.05)。Logistic回归分析显示,hs-CRP是pDOC患者合并肺炎的影响因素。绘制并分析ROC曲线,结果显示,CRP、PCT、hs-CRP预测pDOC患者合并肺炎的曲线下面积(AUC)分别为0.698、0.707、0.698,截断值分别为22.365 mg/L、0.755μg/L、24.25 mg/L;进一步行联合指标分析显示,hs-CRP联合PCT、hs-CRP联合CRP预测pDOC患者合并肺炎的AUC分别为0.725、0.694。结论hs-CRP是pDOC患者合并肺部感染的独立影响因素,hs-CRP联合PCT对pDOC患者合并肺炎的预测价值更优。

Objective To explore the factors of prolonged disorders of consciousness(pDOC)patients complicated with pulmonary infection.Methods The clinical data of 111 patients with pDOC in Department of ICU of Beijing Bo′ai Hospital from Jan.2019 to Apr.2021 were retrospectively analyzed.According to the clinical pulmonary infection score(CPIS),the patients were divided into a simple disorder of consciousness group(CPIS≤6 points,75 cases)and a combined pneumonia group(CPIS>6 points,36 cases).The basic information of the patient,laboratory indicators,chest CT,CPIS and other clinical data were collected.The general information and serological indicators[white blood cell count,C-reactive protein(CRP),procalcitonin(PCT),high-sensitive CRP(hs-CRP),serum albumin,urea nitrogen,serum creatinine,blood lactic acid,D-dimer,N-terminal pro-brain natriuretic peptide(NT-proBNP)]were compared between the two groups to analyze the correlation between clinical serological indicators and CPIS.Logistic regression was used to analyze the influencing factors of pDOC patients with pulmonary infection,and receiver operator characteristic cure(ROC curve)was drawn to analyze the predictive value of clinical serological indicators in pDOC patients with pneumonia.Results There was no statistically significant difference in general data between the two groups(P>0.05).The patients in the combined pneumonia group had higher body temperature,white blood cell count,CRP,PCT,hs-CRP,blood lactic acid,urea nitrogen,and D-dimer than those in the simple disorder of consciousness group[37.1(36.8,37.9)℃vs 37.0(36.5,37.4)℃,12.8(8.8,14.3)×10^(9)/vs 8.8(8.3,11.0)×10^(9)/L,37(15,103)mg/L vs 19(10,54)mg/L,0.53(0.15,3.68)μg/L vs 0.26(0.14,0.61)μg/L,42(17,103)mg/L vs 20(9,46)mg/L,1.60(1.35,1.97)mmol/L vs 1.29(0.96,1.71)mmol/L,8.3(5.3,14.6)mmol/L vs 6.9(4.4,8.7)mmol/L,2.76(1.34,6.00)mg/L FEU vs 1.83(0.85,3.14)mg/L FEU](P<0.05 or P<0.01),and lower serum albumin than that in the simple disorder of consciousness group[33.7(30.8,36.7)g/L vs 35.8(33.5,38.4)g/L](P<0.01).The analysis on correlation between clinical serological indexes and CPIS indicated that body temperature,white blood cell count,CRP,PCT,urea nitrogen,hs-CRP,blood lactic acid,and D-dimer were all positively correlated with CPIS,while serum albumin was negatively correlated with CPIS(P<0.05).Logistic regression analysis showed that hs-CRP could be used as an influential factor in pDOC combined with pneumonia.The ROC curve was drawn and analyzed,and the results showed that the area under cure(AUC)of CRP,PCT,hs-CRP for predicting pDOC patients with pneumonia were 0.698,0.707,and 0.698,respectively,with the cutoff values of 22.365 mg/L,0.755μg/L,and 24.25 mg/L,correspondingly.Further analysis of the combined indicators showed that the AUC of hs-CRP combined with PCT and hs-CRP combined with CRP for predicting pDOC patients complicated with pneumonia were 0.725 and 0.694 respectively.Conclusion hs-CRP is an independent influencing factor for pDOC patients with pulmonary,and the prediction value of hs-CRP combined with PCT for the pDOC patients with pulmonary is better.