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目的探讨血清降钙素原(PCT)水平与急性生理学与慢性健康状况评分(APACHEⅡ)对呼吸机相关性肺炎(VAP)患者预后评估的临床意义。方法选取机械通气时间超过48 h的53例VAP患者和167例非VAP患者为研究对象。按VAP患者临床结局将其分为存活组(42例)及死亡组(11例),采用酶联免疫吸附法(ELISA)检测各组血清PCT水平同时记录APACHEⅡ评分情况,分别比较PCT水平的差异以及与APACHEⅡ评分的相关性,评价血清PCT及APACHEⅡ评分对VAP患者预后的预测价值。结果 VAP组患者血清PCT水平及APACHEⅡ评分明显高于非VAP组患者(P<0.05),同时VAP组死亡率(20.8%)也显著高于非VAP组(10.8%)(P<0.05);死亡组PCT水平及APACHEⅡ评分显著高于存活组(P<0.05)。相关性分析显示,血清PCT水平与APACHEⅡ评分呈正相关(r=0.623,P=0.000)。ROC曲线分析显示,血清PCT曲线下面积(ACU)为0.832(95%CI:0.795~0.914),其最佳工作点为1.84 ng/ml,此时判断VAP患者预后不良的敏感性为81.05%及特异性为83.60%;APACHEⅡ评分ACU为0.845(95%CI:0.789~0.921),其最佳工作点为21.5分,此时判断VAP患者预后不良的敏感性为84.63%,特异性为80.17%。结论 VAP患者血清PCT水平和APACHEⅡ评分呈现较好的相关性,APACHEⅡ评分越高,血清PCT水平越高,预后也越差,两者联合可作为预测VAP患者病情严重程度及预后的敏感指标,具有较好的临床运用价值。
Objective To investigate the clinical significance of serum procalcitonin (PCT) level and acute physiology and chronic health status score (APACHE Ⅱ) in the prognosis evaluation of patients with ventilator-associated pneumonia (VAP). Methods Fifty-three VAP patients with mechanical ventilation over 48 h and 167 non-VAP patients were enrolled in this study. According to the clinical outcome of VAP, the patients were divided into survival group (n = 42) and death group (n = 11). ELISA method was used to detect serum PCT level and APACHEⅡ score, and PCT differences were compared And the correlation with APACHEⅡscore, to evaluate the predictive value of serum PCT and APACHEⅡscore in the prognosis of VAP. Results The serum PCT level and APACHEⅡ score in VAP group were significantly higher than those in non-VAP group (P <0.05), and the VAP group (20.8%) was significantly higher than non-VAP group (10.8%) (P <0.05) PCT group and APACHE Ⅱ score were significantly higher than those in survival group (P <0.05). Correlation analysis showed that there was a positive correlation between serum PCT level and APACHEⅡscore (r = 0.623, P = 0.000). ROC curve analysis showed that the area under the curve of serum PCT (ACU) was 0.832 (95% CI: 0.795-0.914) and the best working point was 1.84 ng / ml. The sensitivity of determining the poor prognosis of VAP patients was 81.05% The specificity was 83.60%. The APACHEⅡ score was 0.845 (95% CI: 0.789-0.921). The best working point was 21.5 points. The sensitivity and the specificity of the APACHE Ⅱ score was 84.63% and 80.17%, respectively. Conclusions There is a good correlation between serum PCT level and APACHE Ⅱ score in VAP patients. The higher the APACHE Ⅱ score, the higher the serum PCT level, the worse the prognosis. The combination of the two can be used as a sensitive index to predict the severity and prognosis of patients with VAP. Better clinical value.