可溶性白细胞分化抗原14亚型对老年急性左心衰竭合并肺炎的临床诊断价值

目的:探讨白细胞分化抗原14亚型(sCD14-ST, presepsin)对老年急性左心衰竭合并细菌性肺炎的临床诊断价值。方法:回顾性分析本院急诊科2017年8月至2018年8月入院的单纯老年急性左心衰竭（对照组）和老年急性左心衰竭合并细菌性肺炎患者共111例。应用化学发光免疫测试法检测所有研究对象外周血presepsin,同时搜集其他临床资料如发热、血降钙素原、C反应蛋白、血白细胞等。组间比较以上参数的差异，Logistic回归分析影响老年急性左心衰竭合并细菌性肺炎诊断的独立危险因素；绘制受试者工作特征曲线，分析presepsin、降钙素原和白细胞对于鉴别诊断的价值。结果:合并细菌性肺炎组患者入院时血presepsin（500.9±283.5）ng/L高于对照组（167.7±102.3）ng/L，差异有统计学意义（t=-7.902, P=0.000）。多因素Logistic回归分析结果表明presepsin升高、降钙素原升高和发热是诊断合并细菌性肺炎的独立危险因素。ROC曲线结果显示入院时血presepsin的ROC曲线下面积为0.887(95% CI: 0.825~0.949， P<0.001)，降钙素原的ROC曲线下面积为0.794(95% CI: 0.704~0.885， P<0.001)，血白细胞的ROC曲线下面积为0.566(95% CI: 0.455~0.678， P=0.231)。presepsin取截断值为227 ng/L时诊断的敏感度为82.0%，特异度为83.6%，阳性似然比为5，阴性似然比为0.22，阳性预测值为80.4%，阴性预测值为85%。 结论:Presepsin对鉴别老年急性左心衰竭合并细菌性肺炎有重要诊断价值。

Clinical diagnostic value of presepsin in elderly patients of acute left heart failure complicated with pneumonia

Objective:To investigate the clinical diagnostic value of soluble leukocyte differentiation antigen 14 subtype (sCD14-ST, presepsin) in elderly patients with acute left heart failure (AHF) complicated with bacterial pneumonia.Methods:The data of 111 elderly patients with acute left heart failure complicated with bacterial pneumonia or acute left heart failure (the control group) who were admitted into emergency department from August 2017 to August 2018 were retrospectively analyzed. Chemilluminescence immunoassay was performed to detect presepsin in all patients. And meanwhile, fever or not, presepsin, procalcitonin (PCT), C-reaction protein (CRP) and other clinical data were compared between the two groups. Univariate and multivariate logistic regression analysis were adopted to screen the risk factor influencing the diagnosis. The receiver operating characteristic (ROC) curve was used to analyze the clinical value of presepsin on diagnosing acute left heart failure complicated with bacterial pneumonia in elderly patients.Results:Presepsin of the group complicated with bacterial pneumonia was significantly higher than that of the control group (500.9±283.5) ng/L vs. (167.7±102.3) ng/L, t=-7.902, P=0.000]. The logistic regression analysis, showed that fever, presepsin and procalcitonin were independent risk factors for AHF combined with bacterial pneumonia diagnosis. The area under ROC curve (AUC) of presepsin, PCT and WBC was 0.887 (95% CI: 0.825-0.949, P<0.001), 0.794(95% CI: 0.704-0.885, P<0.001), and 0.566 (95% CI: 0.455-0.678, P=0.231), respectively. The optimal threshold value of presepsin was 227 ng/L, the sensitivity was 82.0%, specificity was 83.6%, the positive likelihood ratio was 5, the negative likelihood ratio was 0.22, the positive predictive value) was 80.4%, and the negative predictive value was 85%. Conclusions:Presepsin has an important diagnostic value for the identification of AHF combined with bacterial pneumonia in elderly patients.