摘要
目的探究血清中性粒细胞/淋巴细胞比值(NLR)、可溶性血红蛋白清道夫受体(sCD163)及25羟基维生素D[25-(OH)D]水平在老年重症医学科(ICU)呼吸机相关性肺炎(VAP)患者预测及预后评估中的应用价值。方法选择2017年10月-2020年10月龙华医院ICU的63例VAP患者纳入观察组,50例非VAP患者纳入对照组,比较2组血清NLR、sCD163及25-(OH)D水平,比较预后情况不同的VAP患者血清NLR、sCD163及25-(OH)D水平,用spearman法分析血清NLR、sCD163及25-(OH)D水平与ICU呼吸机相关性肺炎患者预后的相关性;用logistic回归分析老年ICU呼吸机相关性肺炎的影响因素;用受试者工作特征曲线(ROC),分析血清NLR、sCD163及25-(OH)D水平预测老年ICU呼吸机相关性肺炎的价值。结果观察组血清NLR、sCD163水平显著高于对照组(P<0.05);血清25-(OH)D水平显著低于对照组(P<0.05);死亡患者血清NLR、sCD163水平显著高于生存患者(P<0.05),血清25-(OH)D水平显著低于生存患者(P<0.05);血清NLR、sCD163水平与老年ICU呼吸机相关性肺炎患者死亡呈正相关(P<0.05),血清25-(OH)D水平与老年ICU呼吸机相关性肺炎患者死亡呈负相关(P<0.05);血清NLR和sCD163水平升高及25-(OH)D水平下降是发生老年ICU呼吸机相关性肺炎的危险因素(P<0.05);血清NLR、sCD163、25-(OH)D联合预测老年ICU呼吸机相关性肺炎的AUC为0.952,敏感性为95.25%,特异性为84.04%,准确性为91.69%,截断值依次分别为7.77 N/L、133.21 pg/mL、55.77 nmol/L。结论联合检测血清NLR、sCD163及25-(OH)D水平有助于预测老年ICU呼吸机相关性肺炎及评估患者预后,应加强这些指标的监测。
Objective To explore the application value of serum neutrophil/lymphocyte ratio(NLR),soluble hemoglobin scavenger receptor(scd163) and 25 hydroxyvitamin D [25-(OH) D] levels in the prediction and prognosis evaluation of ventilator-related pneumonia(VAP) in Geriatric Intensive Care Unit(ICU).Methods 63 patients with VAP in Geriatric ICU of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October 2017 to October 2020 were included in the observation group,and 50 patients without VAP were included in the control group.The levels of serum NLR,scd163 and 25-(OH) D were compared between the two groups,and the levels of serum NLR,scd163 and 25-(OH) D in VAP patients with different prognosis were compared.Spearman method was used to analyze the correlation between the levels of serum NLR,sCD163 and 25-(OH) D and the prognosis of VAP patients in Geriatric ICU.Logistic regression analysis was used to analyze the influencing factors of VAP in Geriatric ICU.Receiver operating characteristic curve(ROC) was used to analyze the value of serum NLR,scd163 and 25-(OH) D levels in predicting VAP in Geriatric ICU.Results The levels of serum NLR and scd163 of the observation group were higher than those of the control group(P<0.05);the level of serum 25-(OH)D were lower than that of the control group(P<0.05);the levels of serum NLR and scd163 of the dead patients were higher than those of the survival patients(P<0.05),the level of serum 25-(OH) D of the dead patients were lower than that of the survival patients(P<0.05).The levels of serum NLR and scd163 were positively correlated with the death of VAP patients in Geriatric ICU(P<0.05),and serum 25-(OH) D level was negatively correlated with the death of VAP patients in Geriatric ICU(P<0.05).Increased serum NLR and scd163 levels and decreased 25-(OH) D levels were risk factors for VAP in Geriatric ICU(P<0.05).The AUC of combined detection of serum NLR,scd163 and 25-(OH) D in predicting VAP in Geriatric ICU was 0.952,the sensitivity was 95.25%,the specificity was 84.04%,the accuracy was 91.69%,and the cut-off values were 7.77 n/L,133.21 pg/ml and 55.77 nmol/L,respectively.Conclusion The combined detection of serum NLR,sCD163 and 25-(OH) D levels is helpful to predict VAP in Geriatric ICU and evaluate the prognosis of elderly VAP patients.The monitoring of these indicators should be strengthened.
作者
孔庆寅
孙鑫
陈伟
Kong Qingyin;Sun Xin;Chen Wei(ICU,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,200032,P.R.China)
出处
《老年医学与保健》
CAS
2021年第2期273-277,共5页
Geriatrics & Health Care
