[1]文小玲,周 盈,吴桂辉.肺部感染评分、血清肾上腺髓质素前体、降钙素原对急性呼吸窘迫综合征并发呼吸机相关性肺炎患者病情及治疗预后的临床研究[J].陕西医学杂志,2023,52(4):408-413.[doi:DOI:10.3969/j.issn.1000-7377.2023.04.010]
　WEN Xiaoling,ZHOU Ying,WU Guihui.Correlation between CPIS score and serum pro-ADM,PCT in patients with ARDS complicated with ventilator-associated pneumonia[J].,2023,52(4):408-413.[doi:DOI:10.3969/j.issn.1000-7377.2023.04.010]
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肺部感染评分、血清肾上腺髓质素前体、降钙素原对急性呼吸窘迫综合征并发呼吸机相关性肺炎患者病情及治疗预后的临床研究
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年4期
页码:
408-413
栏目:
临床研究
出版日期:
2023-04-05

文章信息/Info

Title:
Correlation between CPIS score and serum pro-ADM,PCT in patients with ARDS complicated with ventilator-associated pneumonia
作者:
文小玲1; 周 盈1; 吴桂辉2
(1.成都西区医院重症医学科,四川 成都 610036; 2.成都市公共卫生临床医疗中心结核科,四川 成都611843)
Author(s):
WEN Xiaoling; ZHOU Ying; WU Guihui
(Department of Critical Care Medicine,Chengdu West Hospital,Chengdu 610036,China)
关键词:
急性呼吸窘迫综合征;  呼吸机相关性肺炎;  临床肺部感染评分;  血清肾上腺髓质素前体;  血清降钙素原;  病情;  预后
Keywords:
Acute respiratory distress syndrome;  Ventilator-associated pneumonia;  Clinical pulmonary infection score;  Serum adrenomedullin precursor;  Serum procalcitonin;  Disease condition;  Prognosis
分类号:
R 563
DOI:
DOI:10.3969/j.issn.1000-7377.2023.04.010
文献标志码:
A
摘要:
目的:探讨临床肺部感染评分(CPIS)、血清肾上腺髓质素前体(pro-ADM)、血清降钙素原(PCT)对急性呼吸窘迫综合征(ARDS)并发呼吸机相关性肺炎(VAP)患者的病情及治疗预后的相关性。方法:回顾性分析收治的急性呼吸窘迫综合征并发呼吸机相关性肺炎92例患者资料,将其中继发脓毒症、多器官功能障碍综合征(MODS)或全因死亡的46例患者纳入预后不良组,治疗后好转无其他危重继发症的46例患者纳入预后良好组。对比两组患者CPIS评分、血清pro-ADM、血清PCT水平,分析CPIS评分及血清pro-ADM、PCT水平与ARDS并发VAP患者病情及治疗不良预后的相关性。结果:不良组患者CPIS评分、血清pro-ADM、PCT水平均高于良好组(均P<0.05); CPIS评分与血清pro-ADM、PCT均为ARDS并发VAP不良预后的独立危险因素(均P<0.05); 三项指标中血清pro-ADM对于ARDS并发VAP不良预后诊断的特异性最高为89.13%,CPIS敏感度最高为82.61%、诊断价值(AUC=0.882),三项指标联合应用诊断价值最高(AUC=0.940,P<0.05); 不良组患者PSI评分高于良好组(P<0.05),良好组PSI分级整体水平优于不良组(P<0.05); 血清pro-ADM、PCT、CPIS与PSI评分间均具有高度正相关性(均P<0.05),经多元回归分析血清pro-ADM、PCT、CPIS与PSI评分间相关性良好(均P<0.05)。结论:CPIS评分和血清pro-ADM、PCT对于急性呼吸窘迫综合征并发呼吸机相关性肺炎不良预后具有较高诊断价值,CPIS评分和血清pro-ADM、PCT升高水平与急性呼吸窘迫综合征并发呼吸机相关性肺炎病情呈高度正相关,且为急性呼吸窘迫综合征并发呼吸机相关性肺炎不良预后的独立危险因素,临床对ARDS并发VAP患者评估CPIS评分、监测血清pro-ADM、PCT水平可为病情评估与不良预后提供量化性参考。
Abstract:
Objective:To investigate the correlation between clinical pulmonary infection score(CPIS),serum adrenomedullin precursor(pro-ADM)and procalcitonin(PCT)in patients with acute respiratory distress syndrome(ARDS)complicated with ventilator-associated pneumonia(VAP)and their prognosis.Methods:A retrospective analysis was performed on the clinical data of 92 ARDS patients complicated with VAP.Among them,46 patients with secondary sepsis,multiple organ dysfunction syndrome(MODS)or all-cause death were included in the poor prognosis group,and 46 patients without other critical secondary diseases were included in the good prognosis group.The CPIS score,serum pro-ADM and serum PCT levels were compared between the two groups,and the correlation between CPIS score,serum pro-ADM and PCT levels and the condition and poor prognosis of ARDS patients complicated with VAP was analyzed.Results:The CPIS score,serum pro-ADM and PCT levels in the poor prognosis group were higher than those in the good prognosis group(all P<0.05).CPIS score,serum pro-ADM and PCT were independent risk factors for the poor prognosis of ARDS complicated with VAP(all P<0.05).Among the three indicators,serum pro-ADM had the highest specificity of 89.13% for the poor prognosis of ARDS complicated with VAP,CPIS had the highest sensitivity of 82.61% and the highest diagnostic value(AUC=0.882),and the combined application of the three indicators had the highest diagnostic value(AUC=0.940,P<0.05).The PSI score in the poor prognosis group was higher than that in the good prognosis group,and the overall level of PSI grade in the good prognosis group was better than that in the poor prognosis group(all P<0.05).Serum pro-ADM,PCT,CPIS were highly positively correlated with PSI score(all P<0.05).Multiple regression analysis showed that serum pro-ADM,PCT,CPIS were well correlated with PSI score(all P<0.05).Conclusion:CPIS score,serum pro-ADM and PCT have high diagnostic value for the poor prognosis of ARDS complicated with VAP.CPIS score,serum pro-ADM and PCT levels are highly positively correlated with the condition of ARDS complicated with VAP,and they are independent risk factors for poor prognosis of ARDS complicated with VAP.Clinical evaluation of CPIS score and monitoring of serum pro-ADM and PCT levels in patients with ARDS complicated with VAP can provide quantitative reference for disease evaluation and poor prognosis.

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备注/Memo

备注/Memo:
基金项目:四川省医学会医学科研课题(S18027)
更新日期/Last Update: 2023-04-06