标题：血清D-二聚体、降钙素原联合APACHEⅡ评分对老年SCAP患者预后的预测价值

      作者：李朝晖，李复红，韩蓓，吕凌    渭南市中心医院呼吸与危重症医学科，陕西 渭南 714000

      卷次： 2020年31卷14期

      【摘要】 目的 探讨血清D-二聚体、降钙素原(PCT)联合急性生理和慢性健康状况评分Ⅱ (APACHEⅡ)预测老年重症社区获得性肺炎(SCAP)患者预后的价值。方法 回顾性分析2017年8月至2019年9月渭南市中心医院呼吸与危重症医学科收治的84例SCAP患者(SCAP组)的临床资料，根据疾病转归情况分为生存组50例和死亡组34例，另选择同期收治的90例社区获得性肺炎(CAP)患者作为对照组。分别比较SCAP组和对照组患者、生存组与死亡组患者的血清D-二聚体、PCT水平和APACHEⅡ评分，利用ROC曲线评估D-二聚体、PCT和APACHEⅡ评分对SCAP患者预后的评估价值。结果 SCAP组和对照组患者的血清D-二聚体[ (1.93±0.55) μg/mL vs (0.79±0.23) μg/mL]、PCT [(0.81±0.38) ng/mL vs (0.47±0.15) ng/mL]水平和APACHEⅡ评分[(16.71±2.19)分 vs (10.12±1.46)分]比较，SCAP组明显高于对照组，差异均有统计学意义(P<0.05)；死亡组和生存组患者血清D-二聚体[(2.62±0.64) μg/mL vs (1.71±0.22) μg/mL]、PCT[(1.46±0.56) ng/mL vs (0.62±0.24) ng/mL]水平和APACHEⅡ评分[(17.71±3.17)分 vs (14.36±1.54)分]比较，死亡组明显高于生存组，差异均有统计学意义(P<0.05)；经 Spearman相关分析，SCAP患者血清中D-二聚体、PCT水平与APACHEⅡ评分呈正相关(r=0.283、0.428，P<0.05)；ROC曲线分析结果显示，血清D-二聚体、PCT与APACHEⅡ评分联合预测老年SCAP患者预后的曲线下面积(AUC)为 0.896，高于单一指标。结论 血清D-二聚体、PCT联合APACHEⅡ评分能更准确预测SCAP患者的预后。
      【关键词】 老年；重症；社区获得性肺炎；降钙素原；APACHEⅡ评分；预后
      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350（2020）14—1790—04

Prognostic value of serum D-dimer and procalcitonin combined with APACHEⅡ scores in elderly patients withsevere community-acquired pneumonia.
LI Chao-hui, LI Fu-hong, HAN Bei, LV Ling. Department of Respiratory andCritical Care Medicine, Weinan Central Hospital, Weinan 714000, Shaanxi, CHINA
【Abstract】 Objective To explore the prognostic value of serum D-dimer (D-D), procalcitonin (PCT) combinedwith acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ) in elderly patients with severe communi-ty-acquired pneumonia (SCAP). Methods The clinical data of 84 SCAP patients (SCAP group) who admitted to De-partment of Respiratory and Critical Care Medicine in Weinan Central Hospital from August 2017 to September 2019were retrospectively analyzed. According to disease outcomes, they were divided into survival group (50 cases) anddeath group (34 cases). Ninety patients with community-acquired pneumonia (CAP) who were admitted during the sameperiod were enrolled as control group. The levels of serum D-D and PCT, and APACHE Ⅱ scores were compared be-tween SCAP group and control group, survival group and death group. The evaluation value of D-D, PCT and APACHEⅡ scores on prognosis of SCAP patients was assessed by ROC curves. Results The levels of serum D-D and PCT, andAPACHE Ⅱ scores in SCAP group were significantly higher than those in the control group: (1.93 ± 0.55) μg/mL vs(0.79 ± 0.23) μg/mL, (0.81 ± 0.38) ng/mL vs (0.47 ± 0.15) ng/mL, (16.71 ± 2.19) points vs (10.12 ± 1.46) points, P<0.05.The levels of serum D-D and PCT, and APACHEⅡ scores in death group were significantly higher than those in surviv-al group: (2.62 ± 0.64) μg/mL vs (1.71 ± 0.22) μg/mL, (1.46 ± 0.56) ng/mL vs (0.62 ± 0.24) ng/mL, (17.71 ± 3.17) pointsvs (14.36 ± 1.54) points, P<0.05. Spearman correlation analysis showed that serum D-D and PCT levels in SCAP pa-tients were positively correlated with APACHE Ⅱ score (r=0.283, 0.428, P<0.05). The results of ROC curve analysisshowed that the area under the curve (AUC) of serum D-dimer, PCT combined with APACHE Ⅱ scores to predict theprognosis of elderly SCAP patients was 0.896, which were higher than that of each single index. Conclusion SerumD-D, PCT combined APACHEⅡ score can more accurately predict the prognosis of SCAP patients.
      【Key words】 Elderly; Severe; Community-acquired pneumonia (CAP); Procalcitonin (PCT); Acute physiologyand chronic health evaluationⅡ score (APACHEⅡ); Prognosis