血清降钙素原及和肽素水平对危重患者医院获得性肺炎的预后评估价值

摘要

目的 探讨血清降钙素原(PCT)及和肽素(Copeptin)水平在危重患者医院获得性肺炎(HAP)中的预后评估价值.方法 选取海南省第三人民医院收治的危重患者HAP 142例,记录HAP患者一般资料及病原菌分布情况,并于确诊当天(第0天)、第3天、第7天分别检测血清PCT和Copeptin水平变化.根据HAP患者28 d的生存情况分为存活组(102例)和死亡组(40例),比较两组血清PCT和Copeptin水平的动态变化.应用单因素及多元Logistic回归模型分析影响HAP患者预后的危险因素,并绘制ROC曲线评估血清PCT和Copeptin水平对HAP患者预后的预测价值.结果 142例HAP患者,共分离出病原菌175株,以金黄色葡萄菌、铜绿假单胞菌和不动杆菌属多见.死亡组的年龄、ICU停留时间、CPIS、APACHEⅡ与存活组比较,差异有统计学意义(P<0.05).死亡组血清PCT水平第3天[(4.62±2.36)ng/mL vs.(0.75±0.63)ng/mL]及第7天[(6.83±3.52)ng/mL vs.(0.42±0.27)ng/mL]均明显高于存活组(P<0.05);死亡组血清Copeptin水平第0天[(72.64±12.83)pmol/L vs.(41.63±9.35)pmol/L]、第3天[(77.45±15.61)pmol/L vs.(36.72±10.67)pmol/L]及第7天[(84.52±18.47)pmol/L vs.(28.14±8.73)pmol/L]均明显高于存活组(P<0.05).单因素及多元Logistic回归分析,发现PCT、Copeptin是HAP患者死亡的独立危险因素,其OR及95%CI分别为1.517(1.305~1.864)、2.064(1.958~3.175).ROC曲线显示,PCT第3天和Copeptin第3天的临界值分别为1.14 ng/mL、46.72 pmol/L时,对预测HAP患者死亡的敏感度和特异度最好,分别为79.5%、88.6%,77.3%、84.2%.相关分析显示,血清PCT与Copeptin水平呈正相关(r=0.438,P=0.021;r=0.526,P=0.003;r=0.473,P=0.016).结论 血清PCT和Copeptin水平是HAP患者死亡的独立危险因素,第3天的血清PCT和Copeptin的变化预测HAP患者的预后最有力.%Objective To investigate the prognostic value of serum procalcitonin(PCT)and co-peptin levels in patients with hospital-acquired pneumonia(HAP)in critically ill patients. Methods The third People's Hospital of Hainan province was selected in critically ill patients with hospital-ac-quired pneumonia in 142 cases. The general data and pathogenic bacteria distribution in patients with HAP were recorded, and confirmed by the zeroth day, third day and seventh day respectively to detect the changes of serum PCT and copeptin levels. According to the 28 days survival of HAP, patients were divided into survival group(102 cases)and death group(40 cases), the dynamic changes of serum PCT and copeptin levels were compared between the two groups. Univariate and multivariate logistic regression analysis were used to analyze the prognostic factors of HAP patients, and to draw the ROC curve to evaluate the prognostic value of serum PCT and copeptin levels in patients with HAP. Results A total of 142 HAP patients were isolated from 175 strains of pathogenic bacteria, which were found in Staphylo-coccus aureus, Pseudomonas aeruginosa and Acinetobacter. The death group of age, ICU residence time, CPIS, APACHEⅡand survival group were compared, the difference were statistically significant(P<0.05). The death group third day[(4.62±2.36)ng/mL vs.(0.75±0.63)ng/mL]and seventh day[(6.83± 3.52)ng/mL vs.(0.42±0.27)ng/mL]of serum PCT levels were significantly higher than those in the survival group(P<0.05). The death group on zeroth day[(72.64 ± 12.83)pmol/L vs.(41.63 ± 9.35) pmol/L], third day[(77.45±15.61)pmol/L vs.(36.72±10.67)pmol/L]and seventh day[(84.52±18.47) pmol/L vs.(28.14 ± 8.73)pmol/L]of serum copeptin levels were significantly higher than those in the survival group(P<0.05). Univariate and multivariate Logistic regression analysis showed that PCT and copeptin were independent risk factors for death in patients with HAP, the OR and 95%CI were 1.517 (1.305 to 1.864)and 2.064(1.958 to 3.175), respectively. The ROC curves showed that the critical values of PCTthird days and Copeptinthird days were 46.72 pmol/L and 1.14 ng/mL, respectively. The sensitivity and specificity for predicting the death of HAP patients were 79.5%, 88.6%, 84.2% and 77.3%, respectively. Correlation analysis showed that serum PCT and copeptin levels were positively cor-related(r=0.438, P=0.021;r=0.526, P=0.003;r=0.473, P=0.016). Conclusion Serum PCT and Copeptin levels are independent risk factors for death in patients with HAP. The changes of serum PCT and Copeptin on third day can predict the prognosis of patients with HAP.