CAJ | 학술논문

目的：探讨营养及炎性指标对不同年龄段重症下呼吸道感染患者近期预后的评估价值。方法选取2011年10月-2013年2月中国人民解放军成都军区总医院呼吸重症监护病区（ RICU）收治的重症下呼吸道感染患者170例，检测患者入院时血清降钙素原（ PCT）、超敏C反应蛋白（ hs-CRP）、清蛋白（ Alb）、前清蛋白（ PA）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、尿素氮、肌酐、血红蛋白（ Hb）水平和淋巴细胞计数（ LY），运用受试者工作特征（ ROC）曲线计算曲线下面积（ AUC），分析其对患者25 d死亡的预测价值。结果年龄预测25 d内死亡的 ROC 曲线分析结果显示：当年龄为66岁时，灵敏度为90.5%、特异度为37.3%、约登指数为28.2%。103例年龄≥66岁患者20例25 d内死亡，ROC曲线分析结果显示：PCT的AUC为0.786，其后依次为尿素氮、Alb、hs-CRP、PA、LY、LDL-C、肌酐、HDL-C、Hb、TC、TG，AUC均.0.500。25 d死亡组与非死亡组的PCT、尿素氮、Alb及hs-CRP间的AUC差异有统计学意义（ P<0.05），具有独立预测价值。67例年龄<66岁患者8例25 d内死亡，ROC曲线分析结果显示：LDL-C的AUC为0.732，LY的AUC为0.722，其后依次为Alb、PCT、hs-CRP、TC、PA、TG、HDL-C、Hb、肌酐、尿素氮，AUC均.0.500。25 d死亡组与非死亡组的LDL-C和LY的AUC差异有统计学意义（ P<0.05），具有独立预测价值。结论炎性指标预测年龄≥66岁的重症下呼吸道感染患者近期预后的价值较高；营养指标预测年龄<66岁患者近期预后的价值较高。不同疾病状态、不同年龄患者应选择灵敏度高的预测指标。
목적：탐토영양급염성지표대불동년령단중증하호흡도감염환자근기예후적평고개치。방법선취2011년10월-2013년2월중국인민해방군성도군구총의원호흡중증감호병구（ RICU）수치적중증하호흡도감염환자170례，검측환자입원시혈청강개소원（ PCT）、초민C반응단백（ hs-CRP）、청단백（ Alb）、전청단백（ PA）、총담고순（TC）、삼선감유（TG）、고밀도지단백담고순（HDL-C）、저밀도지단백담고순（LDL-C）、뇨소담、기항、혈홍단백（ Hb）수평화림파세포계수（ LY），운용수시자공작특정（ ROC）곡선계산곡선하면적（ AUC），분석기대환자25 d사망적예측개치。결과년령예측25 d내사망적 ROC 곡선분석결과현시：당년령위66세시，령민도위90.5%、특이도위37.3%、약등지수위28.2%。103례년령≥66세환자20례25 d내사망，ROC곡선분석결과현시：PCT적AUC위0.786，기후의차위뇨소담、Alb、hs-CRP、PA、LY、LDL-C、기항、HDL-C、Hb、TC、TG，AUC균.0.500。25 d사망조여비사망조적PCT、뇨소담、Alb급hs-CRP간적AUC차이유통계학의의（ P<0.05），구유독립예측개치。67례년령<66세환자8례25 d내사망，ROC곡선분석결과현시：LDL-C적AUC위0.732，LY적AUC위0.722，기후의차위Alb、PCT、hs-CRP、TC、PA、TG、HDL-C、Hb、기항、뇨소담，AUC균.0.500。25 d사망조여비사망조적LDL-C화LY적AUC차이유통계학의의（ P<0.05），구유독립예측개치。결론염성지표예측년령≥66세적중증하호흡도감염환자근기예후적개치교고；영양지표예측년령<66세환자근기예후적개치교고。불동질병상태、불동년령환자응선택령민도고적예측지표。
Objective To explore the value of the nutritive and inflammatory indexes in predicting the short -term prognosis in severe lower respiratory tract infection( LRTI)patients in various age groups. Methods 170 LRTI patients admitted to the RICU of the PLA Chengdu Military Area Command General Hospital from October 2011 to February 2013 were selected. The PCT,hs-CRP,Alb,PA,TC,TG,HDL-C,LDL-C,BUN,Cr,Hb and LY were assayed among the patients on admis-sion. The AUC was calculated by using the ROC curve,and its value in predicting death in 25 days was analyzed. Results The results of ROC curve of the patientsˊ25-day death predicted by age showed that the sensitivity,specificity and Youdenˊs index were 90. 5%,37. 3% and 28. 2%,respectively at the age of 66. 20 of 103 patients≥66 years old died within 25 days. The re-sults of the analysis of ROC curve:the maximum AUC value of PCT was 0. 786,and the rest were in the following decreasing or-der:BUN . Alb . hs-CRP . PA . LY . LDL-C . Cr . HDL-C . Hb . TC . TG,and the AUC values of them were all . 0. 500. The AUC differences in PCT,BUN,Alb and hs-CRP between the 25-day death groups and the non-death group were statistically significant(P<0. 05). 8 of the 67 patients<66 years old died within 25 days. The results of the analysis of the 25-day death of the patients by ROC curve:the AUC value of LDL-C and LY were 0. 732 and 0. 722,and the rest were in the fol-lowing decreasing order:Alb . PCT . hs-CRP . TC . PA . TG . HDL-C . Hb . Cr . BUN. The AUC differences in LDL-C and LY between the 25-day death group and the non-death group were statistically significant(P<0. 05). Conclusion The predictive value of the inflammatory and proteometabolic indexes for short-term prognosis in LRTI patients≥66 years old is rela-tively high. The predictive value of nutritive index of short-term prognosis in LRTI patients<66 years old is fairly high. Indexes with high predictive value should be selected for patients with different disease conditions and different ages.