CAJ | 학술논문

目的：探讨D-二聚体水平对住院老年重症社区获得性肺炎（CAP）患者30d死亡率的预测价值。方法152例符合诊断标准的老年重症CAP患者纳入研究，入院后即进行D-二聚体、C-反应蛋白（CRP）检测及肺炎严重度指数（PSI）评分，记录患者30d死亡率。采用受试者工作特征曲线（ROC）分析D-二聚体对30d死亡率的预测价值，计算曲线下面积（AUC）。结果 PSI评分Ⅳ级患者的D-二聚体水平为（961.55±186.49）μg/L，Ⅴ级为（1122.53±197.98）μg/L，两者差异有明显统计学意义（t＝5.159，P＜0.001）；死亡患者的D-二聚体水平（1112.59±215.25）μg/L明显高于存活患者的D-二聚体水平（920.46±126.89）μg/L（t＝6.239，P＜0.001）。Pearson相关性分析显示，D-二聚体和PSI有明显相关性（r＝0.47，P＜0.0001）；ROC分析表明D-二聚体的AUC为：0.79（95%CI：0.72～0.85），和PSI的AUC相比差异无统计学意义（0.85，95%CI：0.78～0.91，P＝0.095）。结论 D-二聚体水平对住院老年重症CAP患者30d死亡率有较好预测价值。
목적：탐토D-이취체수평대주원노년중증사구획득성폐염（CAP）환자30d사망솔적예측개치。방법152례부합진단표준적노년중증CAP환자납입연구，입원후즉진행D-이취체、C-반응단백（CRP）검측급폐염엄중도지수（PSI）평분，기록환자30d사망솔。채용수시자공작특정곡선（ROC）분석D-이취체대30d사망솔적예측개치，계산곡선하면적（AUC）。결과 PSI평분Ⅳ급환자적D-이취체수평위（961.55±186.49）μg/L，Ⅴ급위（1122.53±197.98）μg/L，량자차이유명현통계학의의（t＝5.159，P＜0.001）；사망환자적D-이취체수평（1112.59±215.25）μg/L명현고우존활환자적D-이취체수평（920.46±126.89）μg/L（t＝6.239，P＜0.001）。Pearson상관성분석현시，D-이취체화PSI유명현상관성（r＝0.47，P＜0.0001）；ROC분석표명D-이취체적AUC위：0.79（95%CI：0.72～0.85），화PSI적AUC상비차이무통계학의의（0.85，95%CI：0.78～0.91，P＝0.095）。결론 D-이취체수평대주원노년중증CAP환자30d사망솔유교호예측개치。
ObjectiveToinvestigate the value ofplasmaD-dimerlevelin predicting 30-day mortalityfortheelderly patients with severe community-acquired pneumonia (CAP).Methods A total of 152 elderly inpatients(over 60 years old)withidentifiedsevere CAPadmitted in our department from August 2009 to August 2011were enrolled in this study.Immediately after admission,theirblood samples were obtained forplasma levels ofD-dimer and C-reactive protein(CRP),and pneumonia severity index (PSI) was calculated. Clinical and laboratory variables and 30-day mortality were recorded.Receiver operating characteristic(ROC) curve was used to assess the value of D-dimerfor predicting 30-day mortality, and thearea under curve(AUC)was calculated.ResultsTheD-dimer levelswere (961.55±186.49)μg/Lin the patients with PSIscore inclassⅣ, and(1122.53±197.98)μg/L for those with score inclassⅤ, respectively, withsignificant difference betweenthem (t=5.159,P<0.001).The levels were significantlyhigher in non-survivors thaninsurvivors[(1112.59±215.25)vs (920.46±126.89)μg/L,t=6.239,P<0.001].Pearson correlation analysis indicated that D-dimer level was significantly correlated withPSI score (r=0.47,P<0.0001).ROC curve showed that theAUCforD-dimer predictive value was 0.79 (95%CI=0.72 to 0.85), having nosignificant difference with that of PSI score (0.85, 95%CI=0.78 to 0.91, P=0.095).Conclusion D-dimer level is of great valuefor predicting 30-day mortalityin the elderly patients with severeCAP.