CAJ | 학술논문

目的探讨D-二聚体水平对社区获得性肺炎(CAP)患者病情及长期预后的判断价值.方法 2009年6月至2010年12月,复旦大学附属市五医院收治的189例符合诊断标准的CAP患者纳入研究,入院后即进行D-二聚体、降钙素原(PCT)及C反应蛋白(CRP)等指标的检测,进行肺炎严重度指数(PSI)评分,按照D-二聚体水平分为D-二聚体水平升高组(≥500 μg/L,114例)和D-二聚体水平正常组(＜ 500 μg/L,75例).出院后进行为期一年的随访,采用Kaplan-Meier生存曲线比较两组患者一年病死率;采用多因素Logistic回归分析D-二聚体水平对CAP患者长期预后的预测价值.结果 PSI评分Ⅰ～Ⅲ级患者的D-二聚体质量浓度为378.37 μg/L(216.74,649.50) μg/L,Ⅳ级的为673.41 μg/L (544.77,866.85) μg/L,Ⅴ级的为831.58μg/L(591.78,1066.39) μg/L,三者差异有统计学意义(x2=56.58,P＜0.01).Kaplan-Meier分析表明,D-二聚体水平升高组患者一年病死率高于D-二聚体水平正常组(log-rank法,x2=52.51,P＜0.01).多因素Logistic回归分析表明,D-二聚体水平升高是预测CAP患者长期死亡的独立指标(OR =2.05,95％CI:1.48 ～2.61,P＜0.01).结论 D-二聚体水平可作为衡量CAP患者病情严重度及长期预后的独立指标.
목적 탐토D-이취체수평대사구획득성폐염(CAP)환자병정급장기예후적판단개치.방법 2009년6월지2010년12월,복단대학부속시오의원수치적189례부합진단표준적CAP환자납입연구,입원후즉진행D-이취체、강개소원(PCT)급C반응단백(CRP)등지표적검측,진행폐염엄중도지수(PSI)평분,안조D-이취체수평분위D-이취체수평승고조(≥500 μg/L,114례)화D-이취체수평정상조(＜ 500 μg/L,75례).출원후진행위기일년적수방,채용Kaplan-Meier생존곡선비교량조환자일년병사솔;채용다인소Logistic회귀분석D-이취체수평대CAP환자장기예후적예측개치.결과 PSI평분Ⅰ～Ⅲ급환자적D-이취체질량농도위378.37 μg/L(216.74,649.50) μg/L,Ⅳ급적위673.41 μg/L (544.77,866.85) μg/L,Ⅴ급적위831.58μg/L(591.78,1066.39) μg/L,삼자차이유통계학의의(x2=56.58,P＜0.01).Kaplan-Meier분석표명,D-이취체수평승고조환자일년병사솔고우D-이취체수평정상조(log-rank법,x2=52.51,P＜0.01).다인소Logistic회귀분석표명,D-이취체수평승고시예측CAP환자장기사망적독립지표(OR =2.05,95％CI:1.48 ～2.61,P＜0.01).결론 D-이취체수평가작위형량CAP환자병정엄중도급장기예후적독립지표.
Objective To evaluate the value of D-dimer in assessing severity and predicting longterm prognosis in patients with community acquired pneumonia (CAP).Methods From June 2009 to December 2010,a total of 189 patients with CAP were enrolled.After admission,D-dimer,procalcitonin (PCT) and C-reactive protein (CRP) were measured,and Pneumonia Severity Index (PSI) was calculated.They were assigned into two groups according to their D-dimer levels:high D-dimer levels group (D-dimer levels≥500 μg/L) and normal D-dimer levels group (D-dimer levels ＜ 500 μg/L).The followup time was one year.A Kaplan-Meier survive curve was constructed to assess the 1-year mortality,and multivariate logistic regression analysis were used to assess the value of D-dimer for predicting long-term prognosis.Results D-dimer levels increased with increasing PSI class [class Ⅰ-Ⅲ:378.37 μg/L (216.74,649.50) μg/L; class Ⅳ:673.41 μg/L (544.77,866.85) μg/L; class Ⅴ:831.58 μg/L (591.78,1066.39) μg/L,x2 =56.58,P ＜ 0.01].The Kaplan-Meier survival curve showed that 1-year mortality rate of high D-dimer levels group was higher than normal D-dimer levels group (log-rank test,x2 =52.51,P ＜ 0.01).The multivariate logistic regression analysis showed an independent relationship between higher D-dimer levels and long-term mortality (OR =2.05,95％ CI:1.48-2.61,P ＜ 0.01).Conclusion D-dimer is an independent predictor of severity and long-term prognosis in patients with CAP.