重症肺炎并发ARDS患者肺部超声、肺炎程度评分与血清相关生化指标的检测结果及临床价值分析

Analysis of the Detection Results and Clinical Value of Lung Ultrasound,Pneumonia Degree Score and Serum-related Biochemical Indexes in Patients with Severe Pneumonia Complicating ARDS

目的:探讨重症肺炎(SP)并发急性呼吸窘迫综合征(ARDS)患者的肺部超声(LUS)特征、肺炎程度评分结果以及血清相关生化指标的检测结果,并对各项数据的临床价值进行分析。方法:选取2020年12月—2023年12月厦门医学院附属第二医院收治的100例SP并发ARDS患者作为研究对象,所有病例入院后均完成LUS检测、临床肺部感染评分(CPIS)评估以及实验室检查。根据患者入院后28 d内的转归情况,将患者分为预后不良组(n=23)与预后良好组(n=77),比较两组LUS检查特征、CPIS评分以及血清相关生化指标[C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)、白介素-10(IL-10)、前白蛋白(PAB)]的检测数据,分析其预测价值。结果:两组支气管充气征、肺实变征、胸膜异常征的检出率均较高,部分病例伴胸腔积液,但两组各特征检出率比较,差异无统计学意义(P>0.05);预后不良组的CRP、IL-6水平评分均高于对照组,IL-10水平低于对照组,差异有统计学意义(P<0.05);两组PCT与PAB指标比较,差异无统计学意义(P>0.05)。ROC曲线显示,CRP、IL-6、IL-10预测SP并发ADRS患者预后的曲线下面积(AUC)依次为0.768、0.724、0.804,各指标联合的预测效能有显著提升,AUC为0.930。结论:在SP并发ARDS患者中,血清CRP、IL-6、IL-10水平对不良预后的预测有一定的参考价值。

Objective:To explore the lung ultrasound(LUS)characteristics,the results of pneumonia degree score and the detection results of serum-related biochemical indexes in patients with severe pneumonia(SP)complicating acute respiratory distress syndrome(ARDS),and to analyse the clinical value of each data.Method:The clinical data of 100 patients with severe pneumonia complicating ARDS admitted to the Second Hospital of Xiamen Medical College from December 2020 to December 2023 were retrospectively analysed,and all cases completed LUS testing,clinical pulmonary infection score(CPIS)assessment,and laboratory tests after admission.The patients were divided into a poor prognosis group(n=23)and a good prognosis group(n=77)according to their regression within 28 d after admission,and the characteristics of the LUS test,CPIS score,and serum-related biochemical indexes[C-reactive protein(CRP),procalcitoninogen(PCT),interleukin-6(IL-6),interleukin-10(IL-10),proalbumin(PAB)]testing data were compared between the two groups.The test datas were analyzed for their predictive value.Result:The detection rates of bronchial congestion sign,lung solidity sign and pleural abnormality sign were high in both groups,and some cases were accompanied by pleural effusion,but the intergroup differences in the detection rates of each feature were not statistically significant(P>0.05).The CRP,IL-6 levels and CPIS scores of the poor prognosis group were higher than those of the control group(P<0.05),and the IL-10 levels were lower than those of the control group(P<0.05),and the difference between the PCT and PAB indexes of the two groups was not statistically significant(P>0.05).The ROC curves showed that the areas under the curves of CRP,IL-6,and IL-10 for predicting the prognosis of patients with SP complicated by ADRS(AUC)was 0.768,0.724 and 0.804 in that order,and the predictive efficacy of the combination of the indexes was significantly improved,with an AUC of 0.930.Conclusion:In severe pneumonia among patients with concomitant ARDS,the serum CRP,IL-6,and IL-10 levels have a certain reference value for the prediction of poor prognosis.