沈侃,李秀华,邱泽亮,许东伟,闵思特,周萍,沈飞云.红细胞分布宽度对老年社区获得性肺炎危险分层及预后的评估价值[J].内科急危重症杂志,2016,22(2):
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| DOI： |
| 中文关键词: 红细胞分布宽度 社区获得性肺炎 肺炎严重度评分 生物标志物组合 预后 |
| 英文关键词:Red blood cell distribution Community acquired pneumonia Pneumonia severity index combination of biomarkers outcome |
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| 中文摘要: |
| 目的 探讨红细胞分布宽度（RDW）对老年社区获得性肺炎（CAP）病情危重程度的关系及对预后的评估价值。方法 采用回顾性研究的方法.选取2014年1月至2015年5月，上海市浦东新区周浦医院ICU收治的符合社区获得性肺炎（CAP）诊断的老年患者88例，收集患者一般资料，检测血降钙素原（PCT）、C反应蛋白（CRP）、血常规、N氨基末端脑钠肽（NT-proBNP）、D-二聚体检查，行急性生理学与慢性健康状况评分系统Ⅱ（APACHE II）及肺炎严重度评分(PSI)。根据28天预后分为存活组(52例)与死亡组（36例）。分析RDW与PSI评分的关系。采用Logistic回归分析确定老年CAP预后的独立危象因素。绘制受试者工作（ROC）曲线评估RDW与生物标志物组合对老年CAP的预后的预测价值。结果 1.死亡组的RDW、D-二聚体、APACHE II评分及PSI评分明显高于存活组（P＜0.01或P＜0.05）；2.RDW随着PSI评分升高而升高，两者呈正相关关系（r=0.49 P＜0.01）；3..RDW、D-二聚体、APACHE II评分及PSI评分均是老年CAP患者28天死亡的独立预测因素；4. RDW、D-二聚体的曲线下面积（AUC）分别为0.81、0.76，截断值分别为12.98%，0.43mg/L。RDW联合D-二聚体的AUC为0.86。结论 RDW对老年CAP患者有一定的危险分层级预后评估价值。联合检测RDW及D-二聚体能提高老年CAP预后的评估价值。 |
| 英文摘要: |
| Objective To evaluate the vaule of red blood cell distribution width (RDW) in severity stratification and predicting prognosis in elderly patients with community acquired pneumonia(CAP). Method Adopt the method of retrospective study.From Jaunary 2014 to May 2015,a total 88 elderly patitents with CAP are enrolled. Procalcitonin (PCT) , C-reactive protein (CRP), After admission the blood routine,N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer was measured,the acute physiology and chronic health evaluationⅡ score(APACHE II) and pneumonia severity index(PSI) was calculated. According to the prognosis of 28 days，Patients were divided into survival group and death group.Analysis of the relationship between RDW and PSI rating.A logistic regression analysis was used to determine the independent crisis factors in elderly patients with CAP,Draw the receiver-operating characteristic (ROC) curve to predict vaule between RDW and combination of biomarks.RESULTS 1.The RDW,D-dimer,APACHE II score and PSI score in death group are significantly higher than those in survival group(P＜0.01 or P＜0.05).2. As the PSI rating rises, the RDW increased,both were positively related(r=0.49 P＜0.01).3. RDW, D - dimer, APACHE II score and PSI score are independent predictor of death in elderly patitents with CAP.4.The AUC of RDW and D-dimer are 0.81 and 0.76. The cutoff value is 12.98% and 0.43mg/L,The AUC of biomarkers combination is 0.86.Conclusion RDW is vauleable for prognosis and severity stratification of elderly GAP patients. Joint detection of RDW and D-dimer can improve the prognosis value in elderly patients with CAP. |
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