摘要
目的 探讨血清内皮素-1(endothelin-1,ET-1)水平对呼吸机相关性肺炎(VAP)的诊断价值。方法 选择2018年4月至2020年10月我院收治的150例患者为研究对象,以75例VAP患者为病例组,根据性别、年龄进行1∶1配对,选择同期进行机械通气>48 h但非肺部感染的75例患者为对照组。收集所有患者一般资料,入院24 h内进行临床肺部感染评分(CPIS)并检测ET-1水平。比较各组患者一般资料、CPIS评分与ET-1水平,分析CPIS评分与ET-1水平的相关性,并用受试者工作特征(ROC)曲线分析CPIS评分与ET-1单独使用及联合检测时对VAP的诊断价值。结果 两组患者性别、年龄及入院时急性生理学与慢性健康状况评分系统(APACHE Ⅱ)评分差异均无统计学意义(P均>0.05)。75例VAP患者中共检出病原微生物80株,其中革兰阴性菌48株(60.00%),革兰阳性菌29株(36.25%),真菌3株(3.75%)。CT检查结果显示:所有患者均有右肺下叶病变,其中仅右肺下叶病变者16例,双肺下叶病变者59例。75例VAP患者中有63例出现背部胸膜下区类新月形软组织密度影,15例患者有磨玻璃样改变,9例出现沿肺纹理分布的点状浸润影。观察组患者CPIS评分及血清ET-1水平均高于对照组(P均<0.05)。观察组患者CPIS评分与血清ET-1水平呈正相关(P<0.05)。ROC曲线分析结果显示,CPIS评分、血清ET-1水平对VAP早期诊断的截断值分别为5分、72.04 ng·dL-1;曲线下面积(AUC)分别为0.766、0.862。两者联合诊断的AUC为0.916,其诊断效能高于各指标单独检测(P均<0.05)。结论 CPIS评分及血清ET-1水平联合检测对VAP早期诊断具有较高价值。
Objective To explore the value of serum endothelin-1(ET-1)level in the diagnosis of ventilator associated pneumonia(VAP). Methods From April 2018 to October 2020,150 patients admitted to our hospital were selected as the research subjects,and 75 patients with VAP were selected as the case group.According to gender and age(±5 years old),they were matched 1∶1,and 75 patients with mechanical ventilation>48 hours but without pulmonary infection were selected as the control group. The general data of the two groups of patients were collected,and the clinical pulmonary infection score(CPIS)was used within 24 h of admission and the ET-1 level was measured. The general data,CPIS score and ET-1 level of the two groups of patients were compared. The correlation between CPIS score and ET-1,and was analyzed by ROC analysis to determine the diagnostic value of CPIS score and ET-1 alone and combined detection for VAP.Results There was no significant difference in gender,age and APACHE Ⅱ score between the two groups(P all>0.05). A total of 80 pathogenic bacteria were detected in 75 patients with VAP,of which 48 were Gram-negative bacteria(60.00%),29 Gram-positive bacteria(36.25%),and 3 fungi(3.75%). The results of CT examination showed that all patients had obvious right lower lobe lesions. Among them,only the right lower lobe was 16 cases,and the lower lobe of both lungs was 59 cases. Among 75 patients with VAP,63 cases had crescent-like soft tissue density shadows in the subpleural area of the back,15 cases had ground-glass positive changes,and 9 cases had punctate infiltration shadows distributed along the lung texture. The CPIS score and serum ET-1 level of the observation group were higher than those of the control group(P all<0.05).There was a significant positive correlation between CPIS score and serum ET-1 level in the observation group(P<0.05). ROC analysis results showed that the cut-off values of CPIS score and serum ET-1 for early diagnosis of VAP were 5 points and 72.04 ng·dL-1. The area under the curve(AUC)
作者
孙满媛
白愚
孙贺鑫
高先海
尚晓东
SUN Manyuan;BAI Yu;SUN Hexin;GAO Xianhai;SHANG Xiaodong(Department of Respiratory and Critical Care Medicine,Xincheng Hospital,Liaoyang Central Hospital,Liaoyang 111000,China;Department of Laboratory,Xincheng Hospital,Liaoyang Central Hospital,Liaoyang 111000,China)
出处
《宁夏医科大学学报》
2022年第12期1229-1233,共5页
Journal of Ningxia Medical University
关键词
内皮素
呼吸机相关性肺炎
诊断价值
临床肺部感染评分
endothelin
ventilator-associated pneumonia
diagnostic value
clinical pulmonary infection score
