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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
王力鹏,陈军,罗穆玲,黄浦洋,黎秀文,苏显都.肾上腺髓质素原联合降钙素原对老年重症社区获得性肺炎患者预后的预测价值[J].中华老年多器官疾病杂志,2018,17(3):202~206
肾上腺髓质素原联合降钙素原对老年重症社区获得性肺炎患者预后的预测价值
Prognostic value of proadrenomedullin combined with procalcitonin in the elderly with severe community-acquired pneumonia
投稿时间:2017-10-09  修订日期:2017-11-21
DOI:10.11915/j.issn.1671-5403.2018.03.044
中文关键词:  肺炎;社区获得性感染;降钙素;肾上腺髓质素;预后
英文关键词:pneumonia; community acquired infection; calcitonin; adrenomedullin; prognosis
基金项目:
作者单位E-mail
王力鹏 海南省儋州市人民医院急诊科,儋州 571799 wlpcxy2017@163.com 
陈军 海南省儋州市人民医院急诊科,儋州 571799;海南省儋州市人民医院重症医学科,儋州 571799  
罗穆玲 海南省儋州市人民医院急诊科,儋州 571799  
黄浦洋 海南省儋州市人民医院急诊科,儋州 571799  
黎秀文 海南省儋州市人民医院急诊科,儋州 571799  
苏显都 海南省儋州市人民医院 临床检验科,儋州 571799  
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中文摘要:
      目的 探讨肾上腺髓质素原(pro-ADM)和降钙素原(PCT)在老年重症社区获得性肺炎(SCAP)患者中的变化及其预测预后的价值。方法 回顾性分析2016年1月至2017年9月海南省儋州市人民医院急诊科收治的老年SCAP患者162例,根据患者28 d死亡或存活情况分为存活组(n=114)和死亡组(n=48),监测患者确诊SCAP第1,3,7天时的血清pro-ADM和PCT水平变化。采用SPSS 19.0统计软件对数据进行分析。根据数据类型,组间比较采用成组t检验或χ2检验,组内比较采用重复测量的方差分析;受试者工作特征(ROC)曲线分析各时间点pro-ADM、PCT以及两者联合对老年SCAP患者预后预测的价值。结果 死亡组的CURB-65评分、肺炎严重度指数(PSI)评分及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)分值明显高于存活组,差异具有统计学意义(P<0.05)。死亡组患者确诊第1天[(4.66±1.83) vs(3.04±1.31)nmol/L]、第3天[(5.47±1.96) vs(2.95±1.34)nmol/L]、第7天时[(6.81±2.17) vs(1.53±0.82)nmol/L]血清pro-ADM水平明显高于存活组患者;死亡组患者确诊第3天[(3.28±1.24) vs(1.05±0.53) ng/ml]和第7天[(5.62±1.83) vs(0.26±0.12)ng/ml]时血清PCT水平高于存活组患者;死亡组患者确诊第7天时的pro-ADM[(6.81±2.17) vs(5.47±1.96)nmol/L]和PCT[(5.62±1.83) vs(3.28±1.24)ng/ml]水平明显高于第3天水平, 差异均具有统计学意义(P<0.05)。第3天血清pro-ADM联合PCT预测老年SCAP患者28 d预后的ROC曲线下面积(AUC)是0.942(0.883~0.998),明显高于pro-ADM的0.892(0.830~0.951)和PCT的0.857(0.793~0.924),灵敏度为95.2%,特异度为86.4%,预测价值较好。结论 pro-ADM及PCT水平变化与老年SCAP患者的病情严重程度及预后相关,第3天血清 pro-ADM联合PCT对患者28 d预后的预测价值较好。
英文摘要:
      Objective To investigate the changes of proadrenomedullin (pro-ADM) and procalcitonin (PCT) in the elderly patients with severe community-acquired pneumonia (SCAP), and assess their prognostic value. Methods A total of 162 elderly SCAP patients who were admitted in Emergency Department of our hospital from January 2016 to September 2017 were retrospectively enrolled in this study. According to the 28-day survival, they were divided into survival group (n=114) and death group (n=48). The serum pro-ADM and PCT levels in the patients were measured in 1,3 and 7 d after SCAP diagnosis. SPSS statistics 19.0 was used to perform the statistical analysis. Student’[KG-*3]s t test or Chi-square test was employed for comparison between the 2 groups, and repeated measures analysis of variance for intragroup comparison. Receiver operating characteristic (ROC) curve was adopted to analyze the prognostic value of pro-ADM, PCT and combination for SCAP at various time points. Results The CURB-65 score, pneumonia severity index (PSI), and the score of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) were significantly higher in the death group than the survival group (P<0.05). When compared with the survival group, the serum pro-ADM level was significantly higher in the death group on 1st day [(4.66±1.83) vs (3.04±1.31) nmol/L], 3rd day [(5.47±1.96) vs (2.95±1.34) nmol/L] and 7th day [(6.81±2.17) vs (1.53±0.82) nmol/L, all P<0.05], but such diffe-rences of serum PCT level were only found on the 3rd day [(3.28±1.24) vs (1.05±0.53) ng/ml] and 7th day [(5.62±1.83) vs (0.26±0.12) ng/ml,both P<0.05 ]. The serum pro-ADM and PCT levels on the 7th day were obviously higher than those on the 3rd day in the death group [(6.81±2.17) vs (5.47±1.96) nmol/L, (5.62±1.83) vs (3.28±1.24) ng/ml, P<0.05]. The area under ROC curve of combined diagnosis was 0.942(0.883-0.998) for 28-day prognosis in elderly SCAP patients, significantly higher than that by pro-ADM alone (0.892, 0.830-0.951) or by PCT alone (0.857,0.793-0.924). The sensitivity and specificity were 95.2% and 86.4% respectively, suggesting good predictive value. Conclusion The changes in pro-ADM and PCT levels are associated with the severity of the disease and prognosis in elderly patients with SCAP, and combination of serum pro-ADM and PCT levels on the 3rd day shows good predictive value for 28-day prognosis.
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