摘要
目的探讨嗜酸性粒细胞计数对呼吸机相关肺部感染(VAP)患者生存状况的预后评价。方法选取2015年6月-2016年6月医院ICU使用气管插管或呼吸机辅助通气后诊断为肺部感染的患者124例,根据患者的预后情况分为死亡组和存活组,比较两组患者肺部感染评分、嗜酸性粒细胞计数、机械通气时间、入住ICU和住院时间,采用受试者工作特征(ROC)曲线确定嗜酸粒细胞计数判断预后的临界值,并计算敏感度和特异度。结果死亡组与存活组患者确诊当天到病程结束时抽取的15个时点嗜酸粒细胞计数值比较,差异均有统计学意义(P<0.05),且随着病程延长差异逐渐增大;死亡组和存活组确诊前和发病前3d时肺部感染评分差异无统计学意义,存活组发病后的第5天和第7天的肺部感染评分分值与发病第1天比较均降低,而死亡组的肺部感染评分仍明显增高(P<0.05);存活组机械通气时间、住ICU的时间和住院时间均明显短于死亡组(P<0.05);ROC曲线显示,确诊当天、前7d、前10d、整个病程嗜酸性粒细胞计数判断VAP预后的临界值分别为55×106/L、55×106/L、56×106/L、33×106/L,敏感度分别为0.435、0.478、0.478、0.913,特异度分别为0.800、1.000、1.000、0.867。结论嗜酸粒细胞计数在VAP病程中的变化与预后相关,可作为有效的预后评价指标。
OBJECTIVE To explore the value of eosinophils counts in evaluation of prognosis of VAP patients.METHODS A total of 124 patients who were treated with tracheal intubation or mechanical ventilation in ICUs of the hospital from Jun 2015 to Jun 2016 were enrolled in the study and divided into the death group and the survival group according to the prognosis.The score of pulmonary infections,eosnophils counts,mechanical ventilation duration and length of ICU and hospital stay were compared between the two groups of patients,the critical value of the eosinophils counts in prediction of prognosis was determined by using receiver-operating-characteristic（ROC）curve,and the sensitivity and specificity were calculated.RESULTS There were significant differences in the eosinophils counts between the death group and the survival group at 15 time points from the day of diagnosis to the end of course of disease（P〈0.05）.There was no significant difference in the score of pulmonary infections between the death group and the survival group at 3 days before the diagnosis or onset of disease;the scores of pulmonary infections of the survival group were lower on day 5 and day 7 after onset of disease than on day 1 after the onset,however,the score of pulmonary infections of the death group was significantly increased（P〈0.05）.The mechanical ventilation duration,length of ICU stay and length of hospital stay were significantly shorter in the surgical group than in the death group.The ROC curve indicated that the critical value,sensitivity and specificity of eosinophils counts in prediction of prognosis of the patients with ventilator-associated pulmonary infection were respectively 55×106/L,0.435 and 0.800 on the day of diagnosis,55×106/L,0.478 and 1.000 in the first 7 days before diagnosis,56×106/L,0.478 and 1.000 in the first 10 days before diagnosis,33×106/L,0.913 and 0.867 in the whole course of disease.CONCLUSIONThe change of eosinophils counts is associated with the prognosis during the course of VAP,which can
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第2期180-183,共4页
Chinese Journal of Nosocomiology
关键词
嗜酸粒细胞
呼吸机相关肺部感染
生存状况
Eosinophil
Ventilator-associated pulmonary infection
Survival status
