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目的:探讨老年重症肺炎接受机械通气患者血清超敏C反应蛋白(hs-CRP)与短期预后的关系。方法:将97例老年重症肺炎接受机械通气治疗的患者按照入院第28h的预后分为死亡组(n=34例)和存活组(n=63例),同时按照肺炎严重指数(PSI)和CURB-65评分将患者分为Ⅳ级组(90~130分)(n=29例)和V级组(>130分)(n=68例);CURB-65评分2分组(n=31例)和CURB-65评分3~5分组(n=66例);比较各组患者相关临床指标、入院第1 d、3 d、7 d的血清hs-CRP水平的差异,分析血清hs-CRP水平与近期预后的关系。结果:死亡组与存活组患者在机械通气时间、CURB-65评分、PSI、血清白蛋白(ALB)、降钙素原(PCT)、血乳酸(Lac)方面存在统计学差异(P<0.05);死亡组患者入院第1 d、3 d、7 d的血清hs-CRP水平显著高于死亡组(P<0.05);PSI中V级组,CURB-65评分3~5分组中入院第1 d、3 d、7 d的血清hs-CRP水平亦高于Ⅳ级组和CURB-65评分2分组。血清hs-CRP水平是患者近期死亡的独立危险因素。入院后第1 d、3 d、7 d的血清hs-CRP水平患者死亡的ROCAUC分别为0.844、0.914、0.772,最佳诊断截点分别为51.76 mg/L、92.56 mg/L及49.38 mg/L。结论:血清hs-CRP水平是老年重症肺炎接受机械通气患者近期死亡的独立危险因素,动态检测血清hs-CRP变化对评估患者预后具有一定的临床意义。
Objective: To investigate the relationship between serum hs-CRP and short-term prognosis in elderly patients with severe pneumonia receiving mechanical ventilation. Methods: Ninety-seven elderly patients with severe pneumonia treated with mechanical ventilation were divided into death group (n = 34) and survival group (n = 63) according to the prognosis of 28h admission.According to PSI and CURB Patients were divided into grade IV (n = 29) and grade V (n = 68) for grade IV (n = 29) and grade IV (n = 31) (N = 66). The serum levels of hs-CRP were compared between the groups of patients on the 1st, 3rd, and 7th days after admission, The relationship between the recent prognosis. Results: There was a significant difference (P <0.05) in mechanical ventilation time, CURB-65 score, PSI, serum albumin (ALB), procalcitonin (PCT) and lactic acid (Lac) ; The serum hs-CRP levels in the death group were significantly higher than those in the death group on the 1st, 3rd, and 7th days after admission (P <0.05); in the PSI group V, the CURB-65 score 3 to 5, Serum hs-CRP level was higher on the 3rd and 7th day than that of the IV and CURB-65 score 2 groups. Serum hs-CRP level is an independent risk factor for recent death in patients. The ROCAUC of the serum hs-CRP level at the first day, the third day and the seventh day after admission were 0.844, 0.914 and 0.722, respectively. The best cut-off points were 51.76 mg / L, 92.56 mg / L and 49.38 mg / L . Conclusion: Serum hs-CRP level is an independent risk factor for recent death in patients with severe pneumonia receiving mechanical ventilation. The dynamic changes of serum hs-CRP levels may be of clinical significance in evaluating the prognosis of patients with severe pneumonia.