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目的探讨医院获得性肺炎(HAP)患者血清载脂蛋白E(Apo E)的动态变化及临床意义。方法选择重症监护病房HAP患者112例,健康者30例。测定各组血清Apo E、C反应蛋白(CRP)水平及临床肺部感染评分(CPIS)。动态观察确诊HAP患者的血清Apo E、CRP水平及CPIS的变化趋势。结果呼吸机相关性肺炎(VAP)组在临床疑诊当天血清Apo E(68.2 mg/L±17.1 mg/L)、CRP(65.8 mg/L±11.2 mg/L)及CPIS评分(5.9±1.0)明显高于非VAP组,差异有统计学意义(t=10.279,t=17.785,t=14.638,P<0.05)。HAP存活组患者Apo E水平在第7 d已下降至40.8 mg/L±6.4 mg/L,第14 d已降至对照组水平(33.3 mg/L±6.2 mg/L),HAP死亡组患者Apo E水平在第7 d、第14 d或死亡前持续维持高水平(83.0 mg/L±9.1 mg/L,82.6 mg/L±8.3 mg/L),与存活者在相同时间点比较差异有统计学意义(t=-27.361,t=-34.394,P<0.05)。结论 Apo E是反映HAP的潜在指标,从一定程度上可以判断感染的严重程度以及患者的预后。
Objective To investigate the dynamic changes of serum apolipoprotein E (Apo E) in patients with hospital acquired pneumonia (HAP) and its clinical significance. Methods 112 patients with HAP in intensive care unit and 30 healthy subjects were selected. Serum levels of Apo E and C-reactive protein (CRP) and clinical lung infection score (CPIS) were determined. The level of serum Apo E, CRP and CPIS in patients diagnosed with HAP were dynamically observed. Results Serum levels of Apo E (68.2 mg / L ± 17.1 mg / L), CRP (65.8 mg / L ± 11.2 mg / L) and CPIS score (5.9 ± 1.0) were significantly higher in patients with ventilator- The difference was statistically significant (t = 10.279, t = 17.785, t = 14.638, P <0.05). The levels of Apo E in HAP survivors decreased to 40.8 mg / L ± 6.4 mg / L on the 7th day, and decreased to 33.3 mg / L ± 6.2 mg / L on the 14th day. The levels of Apo in the HAP death group E levels maintained high levels (83.0 mg / L ± 9.1 mg / L, 82.6 mg / L ± 8.3 mg / L) on the 7th day, the 14th day or before death, and statistically significant differences compared with survivors at the same time point Significance (t = -27.361, t = -34.394, P <0.05). Conclusion Apo E is a potential indicator of HAP, to a certain extent, can determine the severity of the infection and the prognosis of patients.