血清可溶性髓样细胞触发受体1、高敏C反应蛋白联合急性生理和慢性健康状况评分Ⅱ对肺炎合并呼吸衰竭患者预后评估的价值

孟超; 范志强; 佟庆; 朱桂军; 朱辉

doi:10.7619/jcmp.20211056

血清可溶性髓样细胞触发受体1、高敏C反应蛋白联合急性生理和慢性健康状况评分Ⅱ对肺炎合并呼吸衰竭患者预后评估的价值

Value of prognostic assessment of soluble triggering receptor expressed on myeloid cell-1, high-sensitivity C-reactive protein combined with the Acute Physiology and Chronic Health Evaluation Ⅱ score in patients with pneumonia complicated with respiratory failure

摘要

摘要:
目的研究血清可溶性髓样细胞触发受体1（sTREM-1）、高敏C反应蛋白（hs-CRP）联合急性生理和慢性健康状况评分Ⅱ（APACHE Ⅱ）对重症肺炎合并呼吸衰竭患者预后评估的价值。
方法选取重症肺炎合并呼吸衰竭患者106例为观察组，另外随机选取同期轻症肺炎患者108例为对照组；根据106例肺炎合并呼吸衰竭患者30 d预后情况分为生存组82例和死亡组24例。检测所有患者sTREM-1、hs-CRP水平并评估APACHE Ⅱ评分情况，分析血清sTREM-1、hs-CRP联合APACHE Ⅱ评分对肺炎合并呼吸衰竭患者不良预后的诊断效能，分析影响肺炎合并呼吸衰竭患者不良预后的危险因素。
结果观察组患者血清sTREM-1、hs-CRP水平及APACHE Ⅱ评分均高于对照组，差异有统计学意义（P < 0.05）。死亡组患者血清sTREM-1、hs-CRP水平及APACHEⅡ评分均高于生存组，差异有统计学意义（P < 0.05）。受试者工作特征（ROC）曲线分析显示，sTREM-1、hs-CRP、APACHE Ⅱ评分诊断肺炎合并呼吸衰竭患者不良预后的曲线下面积（AUC）分别为0.835、0.796、0.866，敏感度分别为82.80%、93.10%、75.90%，特异度分别为80.50%、58.40%、89.60%。联合检测诊断肺炎合并呼吸衰竭患者不良预后的AUC为0.938，敏感度为79.20%，特异度为93.10%。sTREM-1、hs-CRP、APACHE Ⅱ评分是肺炎合并呼吸衰竭患者不良预后的独立影响因素（P < 0.05）。
结论 sTREM-1、hs-CRP联合APACHE Ⅱ评分对肺炎合并呼吸衰竭患者预后具有较好的诊断价值，可为临床及时调整治疗方案提供理论依据。

Abstract:
Objective To study the value of prognostic assessment of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), high-sensitivity C-reactive protein(hs-CRP)combined with the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score in patients with severe pneumonia complicated with respiratory failure.
Methods A total of 106 patients with severe pneumonia complicated with respiratory failure were selected as observation group, and 108 patients with mild pneumonia were randomly selected as control group; A total of 106 patients with pneumonia complicated with respiratory failure were divided into survival group (n=82) and death group (n=24) according to the 30 d prognosis. The levels of sTREM-1, hs-CRP and APACHE Ⅱ score of all the patients were detected; the diagnostic efficacy of serum sTREM-1, hs-CRP combined with APACHE Ⅱ score for the poor prognosis of patients with pneumonia complicated with respiratory failure was analyzed; the risk factors influencing the poor prognosis of patients with pneumonia complicated with respiratory failure were analyzed.
Results The serum levels of sTREM-1, hs-CRP and APACHE Ⅱ score in the observation group were significantly higher than those in the control group (P < 0.05). The serum levels of sTREM-1, hs-CRP and APACHE Ⅱ score in the death group were significantly higher than those in the survival group (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of sTREM-1, hs-CRP and APACHEⅡscore were 0.835, 0.796 and 0.866, respectively, the sensitivities were 82.80%, 93.10% and 75.90%, respectively, and the specificity was 80.50%, 58.40% and 89.60%, respectively. The AUC of combined detection was 0.938, the sensitivity was 79.20%, and the specificity was 93.10%. The sTREM-1, hs-CRP and APACHE Ⅱscore were independent risk factors for poor prognosis of patients with pneumonia complicated with respiratory failure (P < 0.05).
Conclusion The sTREM-1, hs-CRP and APACHE Ⅱ score have good diagnostic value for the prognosis of patients with pneumonia complicated with respiratory failure, and can provide theoretical basis for clinical timely adjustment of treatment plan.

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