| 中性粒细胞CD64指数联合MNA-SF评分预测老年社区获得性肺炎患者预后的价值 |
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| 引用本文： | 廖静贤 申潇竹 苗磊. 中性粒细胞CD64指数联合MNA-SF评分预测老年社区获得性肺炎患者预后的价值[J]. 国际医药卫生导报, 2022, 28(22): 3129-3134. DOI: 10.3760/cma.j.issn.1007-1245.2022.22.005 |
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| 作者姓名： | 廖静贤 申潇竹 苗磊 |
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| 作者单位： | 1南京医科大学康达学院附属连云港第二人民医院老年医学科，连云港 222000；2南京医科大学康达学院附属连云港第二人民医院重症医学科，连云港 222000 |
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| 基金项目： | 江苏省老年健康科研资助项目（临床技术应用研究项目单位建设单位LD2021034，临床技术应用研究项目带头人培养对象LR2021049）；南京医科大学康达学院科研基金项目（KD2021KYJJZD073） |
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| 摘 要： | 目的 探讨中性粒细胞CD64指数联合微型营养评定量表（MNA-SF）评分对老年社区获得性肺炎患者预后的预测价值。方法 2020年1月至2021年12月在连云港市第二人民医院老年科住院的116例60周岁以上诊断为社区获得性肺炎的患者为研究对象。记录入院时的MNA-SF评分，以及第1、3天的C-反应蛋白（CRP）和中性粒细胞CD64指数。根据肺炎严重程度分为重症肺炎组43例［男26例、女17例，年龄（84.02±6.86）岁］和普通肺炎组73例［男41例、女32例，年龄（81.89±8.92）岁］，根据28 d临床转归分为死亡组22例［男11例、女11例，年龄（85.64±6.18）岁］和存活组94例［男56例、女38例，年龄（81.99±8.54）岁］。采用t检验、秩和检验、χ2检验。结果 重症肺炎组和普通肺炎组Charlson合并症指数［（3.47±1.14）分比（2.19±1.15）分］、MNA-SF评分［（6.33±2.00）分比（8.74±2.87）分］及入院第1天和第3天的白细胞计数（WBC）［（13.64±5.89）×109/L比（9.67±4.08）×109/L、（11.91±5.76）×109/L比（7.98±2.38）×109/L］、CRP［107.14（72.06，165.27）mg/L比50.87（22.98，91.13）mg/L、67.93（36.99，111.20）mg/L比16.80（11.40，26.06）mg/L］和CD64指数［3.11（1.78，5.40）比1.27（1.14，2.33）、1.80（1.14，3.15）比1.03（0.69，1.30）］比较，差异均有统计学意义（均P<0.05）。116例病例中共有22例死亡，病死率为18.97%；与存活组相比，死亡组的Charlson合并症指数更高，而MNA-SF评分更低，两组间差异均有统计学意义（均P<0.05）；两组之间入院第1、3天的WBC、CRP和CD64指数差异均有统计学意义（均P<0.05）。炎症指标CRP、CD64指数及WBC预测预后的曲线下面积（AUC）均为第3天大于第1天；其中CRP d1+CD64指数d1+WBC d1+MNA-SF评分预测预后的AUC为0.909，灵敏度为95.5%，特异度为72.9%；CRP d3+CD64指数d3+WBC d3+MNA-SF评分的AUC为0.963，灵敏度为95.5%，特异度为85.9%。logistic回归分析显示，营养不良、CRP d3和CD64指数d1是老年社区获得性肺炎患者死亡的危险因素（均P<0.05）。生存曲线（K-M曲线）分析显示，CD64指数d1 <1.55者28 d存活率显著高于CD64指数d1≥1.55者，两组28 d存活率差异有统计学意义（96.55%比65.52%，χ2=18.027，P<0.001）。结论 中性粒细胞CD64指数联合MNA-SF评分可指导老年社区获得性肺炎患者临床治疗和预测预后。
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| 关 键 词： | 老年 社区获得性肺炎 中性粒细胞CD64指数 营养不良 预后 |
| 收稿时间： | 2022-07-21 |
Value of neutrophil CD64 index combined with MNA-SF nutrition score inpredicting the prognosis of elderly patients with community-acquired pneumonia |
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| Liao Jingxian,Shen Xiaozhu,Miao Lei. Value of neutrophil CD64 index combined with MNA-SF nutrition score inpredicting the prognosis of elderly patients with community-acquired pneumonia[J]. International Medicine & Health Guidance News, 2022, 28(22): 3129-3134. DOI: 10.3760/cma.j.issn.1007-1245.2022.22.005 |
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| Authors: | Liao Jingxian Shen Xiaozhu Miao Lei |
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| Affiliation: | 1 Department of Geriatric Medicine, The SecondPeople's Hospital of Lianyungang Affiliated to Kangda College of NanjingMedical University, Lianyungang 222000, China; 2 Department ofCritical Care Medicine, The Second People's Hospital of Lianyungang Affiliatedto Kangda College of Nanjing Medical University, Lianyungang 222000, China |
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| Abstract: | Objective To investigate the prognostic value of neutrophil CD64 index combinedwith Mini Nutrition Assessment Short Form (MNA-SF) score in elderly patientswith community-acquired pneumonia. Methods A total of 116patients over 60 years old who were hospitalized and diagnosed withcommunity-acquired pneumonia in Department of Geriatric Medicine, The SecondPeople's Hospital of Lianyungang from January 2020 to December 2021 wereselected as the research objects. The MNA-SF nutritional score on admission andC-reactive protein (CRP) and neutrophil CD64 index on the first and third dayafter admission were recorded. According to the severity of pneumonia, thepatients were divided into a severe pneumonia group and a common pneumoniagroup. In the severe pneumonia group, there were 26 males and 17 females, withan age of (84.02±6.86) years old; there were 41 males and 32 females in thecommon pneumonia group, with an age of (81.89±8.92) years old. At the sametime, they were divided into a death group and a survival group according tothe 28-day clinical outcome. There were 11 males and 11 females in the deathgroup, with an age of (85.64±6.18) years old; there were 56 males and 38females in the survival group, with an age of (81.99±8.54) years old. t test, rank sum test, and chi-squaretest were used. Results There werestatistically significant differences in the Charlson comorbidibility index[(3.47±1.14) vs. (2.19±1.15)], MNA-SF score [(6.33±2.00) vs. (8.74±2.87)], andwhite blood cell count (WBC) [(13.64±5.89) ×109/L vs. (9.67±4.08)×109/L, (11.91±5.76) ×109/L vs. (7.98±2.38) ×109/L],CRP [107.14 (72.06, 165.27) mg/L vs. 50.87 (22.98, 91.13) mg/L, 67.93 (36.99,111.20) mg/L vs. 16.80 (11.40, 26.06) mg/L], and CD64 index [3.11 (1.78, 5.40)vs. 1.27 (1.14, 2.33), 1.80 (1.14, 3.15) vs. 1.03 (0.69, 1.30)] on the firstand third day after admission between the severe pneumonia group and the commonpneumonia group (all P<0.05).Among the 116 cases, 22 cases died, with a mortality rate of 18.97%. Comparedwith those in the survival group, the death group had a higher Charlsoncomorbidity index and a lower MNA-SF score, with statistically significantdifferences between the two groups (both P<0.05);there were statistically significant differences in the WBC, CRP, and CD64index on the first and third day after admission between the two groups (all P<0.05). The areas under the curve(AUC) of CRP, CD64 index, and WBC in predicting prognosis were higher on thethird day than those on the first day. The AUC of CRP d1+CD64 index d1+WBC d1+MNA-SFscore in predicting prognosis was 0.909, the sensitivity was 95.5%, and thespecificity was 72.9%; the AUC of CRP d3+CD64 index d3+WBC d3+MNA-SF score was0.963, the sensitivity was 95.5%, and the specificity was 85.9%. Logisticregression analysis showed that malnutrition, CRP d3, and CD64 index d1 wererisk factors for death in elderly patients with community-acquired pneumonia(all P<0.05). The survival curve(K-M curve) analysis showed that the 28-day survival rate in patients with CD64index d1 <1.55 was significantly higher than that in patients with CD64index d1 ≥1.55, and the 28-daysurvival rate of the two groups was statistically significant (96.55% vs.65.52%, χ2=18.027, P<0.001). Conclusion Neutrophil CD64 index combined with MNA-SF nutritional score can guidethe clinical treatment and predict the prognosis of elderly patients withcommunity-acquired pneumonia. |
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| Keywords: | Old age Community-acquired pneumonia Neutrophil CD64 index Malnutrition Prognosis |
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