本文選題：重癥社區(qū)獲得性肺炎 + 可溶性纖溶酶原激活物受體�。� 參考：《中國(guó)呼吸與危重監(jiān)護(hù)雜志》2016年06期

【摘要】：目的探討支氣管肺泡灌洗液(BALF)中的可溶性尿激酶型纖溶酶原激活物受體(su PAR)水平對(duì)重癥社區(qū)獲得性肺炎(SCAP)患者疾病嚴(yán)重程度及預(yù)后評(píng)估的臨床價(jià)值。方法選取2014年4月至2016年4月期間我院呼吸內(nèi)科、ICU、RICU收治的84例SCAP患者作為重癥肺炎組,并依據(jù)患者合并器官功能障礙情況分為重癥肺炎合并多器官功能障礙綜合征(MODS)組、重癥肺炎非MODS組,依據(jù)治療7 d時(shí)治療反應(yīng)不同分為治療有效組和治療無(wú)效組,并根據(jù)入院28 d存活情況分為存活組和死亡組。以同期收治的50例普通社區(qū)獲得性肺炎患者作為對(duì)照組。所有患者入院當(dāng)天均予肺炎嚴(yán)重程度(PSI)評(píng)分、急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ)評(píng)分,采用酶聯(lián)免疫吸附法(ELISA)檢測(cè)入院第1 d血漿su PAR水平,第1、3、7 d、出院或死亡當(dāng)天BALF中su PAR水平和血漿中降鈣素原(PCT)水平。觀察治療過(guò)程中患者癥狀體征、感染指標(biāo)、生化、肺部影像學(xué)變化。結(jié)果重癥肺炎組與對(duì)照組在年齡、性別、體重、肺炎發(fā)生的時(shí)間以及合并的高血壓、冠心病、腦血管疾病等基礎(chǔ)疾病方面比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。重癥肺炎組患者血漿、BALF中su PAR水平均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);重癥肺炎組BALF中su PAR水平高于血漿中水平,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)照組BALF中su PAR水平略高于血漿中的水平,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。重癥肺炎合并MODS組BALF中su PAR水平明顯高于非MODS組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而PCT水平在重癥肺炎合并MODS組與非MODS組之間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。入院第7 d時(shí),治療無(wú)效組患者BALF中su PAR水平明顯高于治療有效組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。死亡組患者入院后各時(shí)間點(diǎn)的BALF中su PAR水平均高于存活組,且差異有統(tǒng)計(jì)學(xué)意義(P0.05),而存活組與死亡組兩組患者血漿PCT水平在1周內(nèi)各時(shí)間點(diǎn)水平相比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。重癥肺炎患者BALF中su PAR水平與患者的APACHEⅡ評(píng)分、PSI評(píng)分值呈正相關(guān)性(r=0.578,P=0.008 5;r=0.565,P=0.007 1),而血漿PCT水平與APACHEⅡ評(píng)分、PSI評(píng)分值則呈弱相關(guān)性(r_1=-0.013 7,r_2=-0.015 2)。結(jié)論 BALF中su PAR可作為一個(gè)能獨(dú)立有效評(píng)估SCAP患者病情嚴(yán)重程度及判斷預(yù)后的生物標(biāo)志物,對(duì)指導(dǎo)臨床治療有重要價(jià)值。
[Abstract]:Objective to investigate the clinical value of soluble urokinase-type plasminogen activator receptor (plasminogen activator receptor) in bronchoalveolar lavage fluid (BALF) in patients with severe community-acquired pneumonia (SCAP). Methods Eighty-four patients with SCAP from April 2014 to April 2016 were selected as severe pneumonia group and divided into severe pneumonia with multiple organ dysfunction syndrome (mods) group. Severe pneumonia non-MODS group was divided into effective group and ineffective group according to the treatment response at 7 days, and divided into survival group and death group according to the survival condition of 28 days after admission. 50 patients with common community acquired pneumonia were treated as control group. On admission day, all patients were assessed with the severity of pneumonia (PSI) score, the acute physiology and chronic health status scoring system 鈪，

本文編號(hào)：1899828