急性卒中患者细菌性肺炎危险因素及早期血清PCT对细菌性肺炎及脓毒症分级的预测价值分析
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摘要
目的探讨急性卒中患者细菌性肺炎危险因素,早期血清PCT对细菌性肺炎和脓毒症分级的预测价值。方法选取我院2015年3月—2017年8月收治的急性卒中患者100例,根据是否发生细菌性肺炎分为卒中相关性肺炎(SAP)组68例,无感染组32例;比较2组的临床资料并做logistic回归分析。采用ROC曲线分析血清降钙素原(PCT)对SAP和脓毒症分级的预测价值。结果 SAP组年龄、GCS评分≤8分、PCT≥0. 05 ng/ml、FPG水平均高于无感染组(P <0. 05)。GCS评分≤8分、PCT≥0. 05 ng/ml、FPG≥6. 1mmol/L是SAP的独立危险因素(P <0. 05)。脓毒症组、严重脓毒症组血清PCT水平均高于局部感染组,且严重脓毒症组高于脓毒症组(P <0. 05)。在对SAP诊断预测价值中,当PCT水平≥0. 070 ng/ml时,特异度为73. 90%,敏感度为84. 10%,ROC曲线下面积为0. 864(P <0. 05)。结论 GCS评分≤8分、PCT≥0. 05 ng/ml、FPG≥6. 1 mmol/L是急性卒中发生细菌性肺炎的独立危险因素,PCT水平对于SAP诊断及脓毒症分级均有较好的预测价值。
Objective To investigate values of risk factors for bacterial pneumonia and early serum procalcitonin( PCT) in prediction of bacterial pneumonia and sepsis classifications in patients with acute stroke. Methods A total of100 patients with acute stroke admitted during March 2015 and August 2017 was retrospectively analyzed,and the patients were divided into stroke-associated pneumonia( SAP) group( n = 68) and non infection group( n = 32) according to whether or not having bacterial pneumonia,In two groups,clinical data was compared,and logistic regression analysis was performed. Receiver operating curve( ROC) was used to analyze value of serum PCT levels in prediction of SAP and sepsis classifications. Results Glasgow coma scale( GCS) score equal or less than 8 points,PCT equal or more than 0.05 ng/m L and fasting plasma glucose( FPG) equal or more than 6. 1 mmol/L were independent risk factors for SAP in patients with acute stroke( P < 0. 05). Levels of serum PCT in sepsis and severe sepsis groups were significantly higher than that in local infection group,and the level in severe sepsis group was significantly higher than that in sepsis group( P< 0. 05). In prediction and diagnosis of SAP value,specificity and sensitivity were 73. 90% and 84. 10% respectively,and the area under ROC was 0. 864 when PCT level was equal or more than 0. 070 ng/ml( P < 0. 05). Conclusion Glasgow coma scale( GCS) score equal or less than 8 points,PCT equal or more than 0. 05 ng/m L and fasting plasma glucose( FPG) equal or more than 6. 1 mmol/L are independent risk factors for bacterial pneumonia in patients with acute stroke,and PCT level has good predictive value for SAP diagnosis and sepsis classification.
Objective To investigate values of risk factors for bacterial pneumonia and early serum procalcitonin( PCT) in prediction of bacterial pneumonia and sepsis classifications in patients with acute stroke. Methods A total of100 patients with acute stroke admitted during March 2015 and August 2017 was retrospectively analyzed,and the patients were divided into stroke-associated pneumonia( SAP) group( n = 68) and non infection group( n = 32) according to whether or not having bacterial pneumonia,In two groups,clinical data was compared,and logistic regression analysis was performed. Receiver operating curve( ROC) was used to analyze value of serum PCT levels in prediction of SAP and sepsis classifications. Results Glasgow coma scale( GCS) score equal or less than 8 points,PCT equal or more than 0.05 ng/m L and fasting plasma glucose( FPG) equal or more than 6. 1 mmol/L were independent risk factors for SAP in patients with acute stroke( P < 0. 05). Levels of serum PCT in sepsis and severe sepsis groups were significantly higher than that in local infection group,and the level in severe sepsis group was significantly higher than that in sepsis group( P< 0. 05). In prediction and diagnosis of SAP value,specificity and sensitivity were 73. 90% and 84. 10% respectively,and the area under ROC was 0. 864 when PCT level was equal or more than 0. 070 ng/ml( P < 0. 05). Conclusion Glasgow coma scale( GCS) score equal or less than 8 points,PCT equal or more than 0. 05 ng/m L and fasting plasma glucose( FPG) equal or more than 6. 1 mmol/L are independent risk factors for bacterial pneumonia in patients with acute stroke,and PCT level has good predictive value for SAP diagnosis and sepsis classification.
引文
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[10]张德文,刘勇,龙林会,等.血清降钙素原检测对慢性肾衰竭患者合并细菌感染的临床应用价值[J].实用医院临床杂志,2017,14(3):59-61.
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[12]颜瑶,郭晓芳,施青山,等.血清降钙素原在细菌性脓毒症合并急性肾损伤患者的诊断价值[J].中国中西医结合肾病杂志,2016,17(3):243-246.
[13]谭德敏,谭孟源,陈军,等.脓毒症患者血清降钙素原的表达及其对预后的影响研究[J].中国全科医学,2017,20(5):520-525.
[14]唐龙,段进进,陈新军,等.肺炎合并脓毒症患者血清hs CRP和PCT水平的变化[J].现代生物医学进展,2016,16(35):6929-6931.
[15]赵若愚,鲍逸民,杨永青.血清PCT、IL-6、NT-proBNP、CTn I和D-D测定水平在急诊脓毒症患者早期诊断中的临床研究[J].标记免疫分析与临床,2016,23(6):613-616.
[16]何勤,樊省廉,李艳.监测血清降钙素原和血小板对肺炎合并脓毒症患儿的预测价值[J].中国临床医生杂志,2015,43(10):73-75.
[17]周海琪,裴颖皓,陈明祺,等.多项指标联合检测在脓毒症患者革兰阴性菌血流感染的临床价值分析[J].中华医院感染学杂志,2016,26(24):5557-5559.
[18]尹良琼,余艾霞.降钙素原、胱抑素C联合检测对脓毒症患儿28天死亡率的预测价值研究[J].现代检验医学杂志,2017,32(2):153-156,159.
[19]马军宇,王书鹏,陈德生,等.血清降钙素原对非脓毒症重症患者疾病严重程度的预测价值[J].中华危重病急救医学,2016,28(8):688-693.
[20]孙茂军,陈琳迪,寇雪莲,等.老年急性脑卒中患者肺部感染危险因素与预防[J].中华医院感染学杂志,2016,26(7):1517-1519.
[21]宋邵华,田惠玉,杨秀芬.降钙素原在可疑细菌感染患者疾病严重程度的早期预警价值[J].内科急危重症杂志,2016,22(1):56-57.
[22]陈太碧,文英旭,邢柏.血清N端脑钠肽前体和降钙素原水平在脓毒症患者中的表达及相关性分析[J].重庆医学,2017,46(14):1924-1926.
[23]尹琮煦.血清降钙素原水平对急性卒中患者细菌性肺炎的预测价值[D].广州:南方医科大学,2015.
[24]高剑平.探讨预防急性脑卒中患者误吸的护理管理方法及效果[J].中国卫生标准管理,2016,7(20):253-254.
[25]李虹光,徐晓军,杨建荣,等.肺炎合并脓毒症患儿血清降钙素原水平变化的临床意义[J].解放军预防医学杂志,2016,34(5):709-711.
[2]李玉芝,程文静.盐酸氨溴索在重症脑卒中并发肺炎患者雾化治疗中应用[J].创伤与急危重病医学,2018,6(4):241-242.
[3]张怡,宗媛,牛丹,等.血清PCT CRP及内毒素在细菌性血流感染所致脓毒症患者中的早期诊断价值[J].河北医学,2016,22(5):768-771.
[4]史江峰,马健.血清降钙素原对不同致病菌感染所致脓毒症的早期诊断及临床研究[J].重庆医学,2017,46(12):1626-1628.
[5] Cao H,Ju K,Zhong L,et al. Efficacy of hyperbaric oxygen treatment for depression in the convalescent stage followingcerebral hemorrhage[J]. Exp Ther Med,2013,5(6):1609-1612.
[6]汪锋平,王利民,刘俊.血清降钙素原和淀粉样蛋白A在老年细菌性肺炎患者中的诊断价值[J].中国卫生检验杂志,2016,26(23):3407-3409.
[7]赵蓉,董士民.血清endocan和降钙素原对脓毒症早期诊断及预后评估的临床价值[J].中华危重病急救医学,2017,29(4):321-326.
[8]白雅红,李月阳,王华,等.降钙素原、C反应蛋白、白细胞计数联合检测对医院获得性细菌性肺炎的诊断价值[J].陕西医学杂志,2017,46(6):807-809.
[9]张运君,卓小岸,周小曼,等.急诊脓毒症患者血清降钙素原的变化及预后危险因素分析[J].重庆医学,2017,46(24):3392-3395.
[10]张德文,刘勇,龙林会,等.血清降钙素原检测对慢性肾衰竭患者合并细菌感染的临床应用价值[J].实用医院临床杂志,2017,14(3):59-61.
[11]闫孝永.血浆肌钙蛋白Ⅰ和NT-proBNP含量对儿童肺炎合并心力衰竭的诊断价值[J].江苏大学学报:医学版,2017,27(4):312-315.
[12]颜瑶,郭晓芳,施青山,等.血清降钙素原在细菌性脓毒症合并急性肾损伤患者的诊断价值[J].中国中西医结合肾病杂志,2016,17(3):243-246.
[13]谭德敏,谭孟源,陈军,等.脓毒症患者血清降钙素原的表达及其对预后的影响研究[J].中国全科医学,2017,20(5):520-525.
[14]唐龙,段进进,陈新军,等.肺炎合并脓毒症患者血清hs CRP和PCT水平的变化[J].现代生物医学进展,2016,16(35):6929-6931.
[15]赵若愚,鲍逸民,杨永青.血清PCT、IL-6、NT-proBNP、CTn I和D-D测定水平在急诊脓毒症患者早期诊断中的临床研究[J].标记免疫分析与临床,2016,23(6):613-616.
[16]何勤,樊省廉,李艳.监测血清降钙素原和血小板对肺炎合并脓毒症患儿的预测价值[J].中国临床医生杂志,2015,43(10):73-75.
[17]周海琪,裴颖皓,陈明祺,等.多项指标联合检测在脓毒症患者革兰阴性菌血流感染的临床价值分析[J].中华医院感染学杂志,2016,26(24):5557-5559.
[18]尹良琼,余艾霞.降钙素原、胱抑素C联合检测对脓毒症患儿28天死亡率的预测价值研究[J].现代检验医学杂志,2017,32(2):153-156,159.
[19]马军宇,王书鹏,陈德生,等.血清降钙素原对非脓毒症重症患者疾病严重程度的预测价值[J].中华危重病急救医学,2016,28(8):688-693.
[20]孙茂军,陈琳迪,寇雪莲,等.老年急性脑卒中患者肺部感染危险因素与预防[J].中华医院感染学杂志,2016,26(7):1517-1519.
[21]宋邵华,田惠玉,杨秀芬.降钙素原在可疑细菌感染患者疾病严重程度的早期预警价值[J].内科急危重症杂志,2016,22(1):56-57.
[22]陈太碧,文英旭,邢柏.血清N端脑钠肽前体和降钙素原水平在脓毒症患者中的表达及相关性分析[J].重庆医学,2017,46(14):1924-1926.
[23]尹琮煦.血清降钙素原水平对急性卒中患者细菌性肺炎的预测价值[D].广州:南方医科大学,2015.
[24]高剑平.探讨预防急性脑卒中患者误吸的护理管理方法及效果[J].中国卫生标准管理,2016,7(20):253-254.
[25]李虹光,徐晓军,杨建荣,等.肺炎合并脓毒症患儿血清降钙素原水平变化的临床意义[J].解放军预防医学杂志,2016,34(5):709-711.