摘要
目的:观察重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)患者的血脂水平变化,探讨血尿素氮与脂蛋白a比值[BUN/Lp(a)]对SCAP患者重症监护病房(ICU)死亡的预测价值。方法:选取2021年3月至2023年3月在急诊重症监护病房(EICU)住院的72例SCAP患者。收集患者EICU入院后12 h内的血液检查结果,以及入院后第1天早晨的血脂和脂蛋白水平。根据患者ICU内是否死亡分为生存组(55例)和死亡组(17例)。采用受试者工作特征曲线和曲线下面积(AUC)评价BUN/Lp(a)比值的预测价值。结果:与生存组比较,死亡组患者白细胞介素-6(IL-6)、BUN、BUN/Lp(a)比值均显著升高(P<0.05)。死亡组患者氧合指数(PaO_(2)/FiO_(2))、血小板计数、Lp(a)均显著低于生存组(P<0.05)。死亡组患者脓毒性休克的比例高于生存组(P=0.05)。IL-6、BUN、BUN/Lp(a)比值与SCAP患者ICU死亡呈弱的正相关性(P<0.05)。PaO_(2)/FiO_(2)和Lp(a)与SCAP患者ICU死亡呈弱的负相关性(P<0.05)。Lp(a)与SCAP患者血小板计数、低密度脂蛋白胆固醇、载脂蛋白B呈正相关性(P<0.05),Lp(a)与IL-6呈负相关性(P<0.05)。血小板计数、PaO_(2)/FiO_(2)、IL-6、BUN、Lp(a)水平和BUN/Lp(a)比值预测SCAP患者ICU死亡的AUC分别为0.665(95%CI 0.544~0.772)、0.709(95%CI 0.590~0.810)、0.660(95%CI 0.539~0.768)、0.678(95%CI 0.558~0.783)、0.776(95%CI 0.662~0.866)和0.809(95%CI 0.699~0.892)(均P<0.05)。AUC两两比较显示,BUN/Lp(a)比值的预测价值优于BUN(P=0.0079)。BUN/Lp(a)比值预测ICU死亡的灵敏度为65.45%,特异度为88.24%(截断值=0.60)。结论:与生存组比较,SCAP患者死亡组的Lp(a)水平在入院时较低。BUN/Lp(a)比值是SCAP患者ICU死亡的良好预测指标,可能成为评估患者预后的一个很好的方法。
Objective To observe the changes in blood lipid levels in patients with severe community-acquired pneumonia(SCAP),and to explore the predictive value of blood urea nitrogen/lipoprotein(a)ratio(BUN/Lp[a])for mortality in intensive care unit(ICU)of SCAP patients.Methods A total of seventy-two patients with SCAP hospitalized in the emergency intensive care unit(EICU)from March 2021 to March 2023 were included.Blood test results were collected within the first 12 h of EICU admission.The plasma lipid and lipoprotein levels in the morning of the first day after EICU admission were collected.The patients were divided into a survival group(55 cases)and a death group(17 cases).The predictive value was evaluated by using receiver operating characteristic curve and the area under the curve(AUC).Results Compared to patients in the survival group,the interleukin-6(IL-6),BUN,and BUN/Lp(a)ratio were significantly increased in patients with the death group(P<0.05).Patients in the death group had significantly lower PaO_(2)/FiO_(2),platelet count,Lp(a)than those in patients with the survival group(P<0.05).The proportion of septic shock in patients in the death group was higher than that in the survival group(P=0.05).IL-6,BUN,and BUN/Lp(a)ratio showed a weak positive correlation with ICU death in patients with SCAP(P<0.05).PaO_(2)/FiO_(2) and Lp(a)showed a weak negative correlation with ICU death in patients with SCAP(P<0.05).Lp(a)was positively correlated with platelet count,low-density lipoprotein cholesterol,and apolipoprotein B(P<0.05),and Lp(a)was negatively correlated with IL-6 in SCAP patients(P<0.05).The AUCs of platelet count,PaO_(2)/FiO_(2),IL-6,BUN,Lp(a)levels,and BUN/Lp(a)ratio for predicting ICU death in patients with SCAP were 0.665(95%CI 0.544-0.772),0.709(95%CI 0.590-0.810),0.660(95%CI 0.539-0.768),0.678(95%CI 0.558-0.783),0.776(95%CI 0.662-0.866)and 0.809(95%CI 0.699-0.892),respectively(P<0.05).A pairwise comparison of AUCs showed that the predictive value of BUN/Lp(a)ratio was significantly better than that of BU
作者
张立涛
徐鑫
ZHANG Litao;XU Xin(Department of Emergency,Hebei General Hospital,Shijiazhuang,050000,China)
出处
《临床急诊杂志》
CAS
2024年第4期198-204,共7页
Journal of Clinical Emergency
基金
河北省卫生健康委员会医学科学研究课题计划(No:20230270)。
关键词
血尿素氮
脂蛋白(a)
重症社区获得性肺炎
重症监护病房
预后
blood urea nitrogen
lipoprotein(a)
severe community-acquired pneumonia
intensive care unit
prognosis
