动态监测血清胆碱酯酶、降钙素原水平有助于重症肺炎患者的预后评估

目的:分析动态监测血清胆碱酯酶(CHE)、降钙素原(PCT)水平对ICU重症肺炎患者预后的评估价值。方法:选取2017年1月-2018年6月重庆市开州区人民医院ICU收治的重症肺炎患者92例,按照转出ICU或出院时病情转归分为好转组(53例)与恶化组(39例)。比较2组患者临床资料与血清CHE、PCT水平及APACHEⅡ评分等指标,采用Spersman等级相关性分析法分析血清CHE、PCT水平与APACHEⅡ评分的相关性,采用多因素Logistic回归分析ICU重症肺炎患者病情恶化的危险因素。结果:入院时,好转组患者MODS评分、C反应蛋白(CRP)以及空腹血糖均明显低于恶化组(P均0. 05);好转组住ICU时间、抗生素应用时间、机械通气及留置导尿管患者比例均明显低于恶化组(P均0. 05)。入院后3、7 d以及转归前,好转组CHE水平明显高于入院时,PCT水平及APACHEⅡ评分明显低于入院时(P均0. 05);恶化组CHE水平明显低于入院时,PCT水平及APACHEⅡ评分明显高于入院时(P均0. 05);入院时、入院后(24 h、3 d、7 d)及转归前,好转组CHE水平明显高于恶化组,PCT水平及APACHEⅡ评分明显低于恶化组(P均0. 05)。血清CHE水平与APACHEⅡ评分呈负相关(r=-0. 531,P 0. 05),血清PCT水平与APACHEⅡ评分呈正相关(r=0. 725,P 0. 05),血清CHE水平与PCT水平呈负相关(r=-0. 564,P 0. 05)。APACHEⅡ评分、MODS评分、血清CHE、PCT、CRP、空腹血糖以及机械通气为ICU重症肺炎患者病情恶化的独立危险因素(P均0. 05)。结论:ICU重症肺炎患者血清CHE水平明显降低、PCT水平明显升高,动态监测血清CHE、PCT水平有助于ICU重症肺炎患者的预后评估。

Dynamic monitoring of serum cholinesterase and procalcitonin levels in evaluating prognosis of ICU patients with severe pneumonia

Objective: To analyze the dynamic monitoring of serum cholinesterase(CHE) and procalcitonin(PCT) levels in evaluating prognosis of ICU patients with severe pneumonia. Methods A total of 92 ICU patients with severe pneumonia in our hospital from Jan. 2017 to Jun. 2018 were selected. According to the outcome of illness out of ICU or at discharge, the patients were divided into the improvement group (n=53) and the deterioration group (n=34). The clinical data, serum CHE, PCT levels and APACHE II score were compared between two groups. The spersman rank correlation analysis was done to analyze the correlation between serum CHE, PCT levels and APACHE II score. The multivariate Logistic regression analysis was done to analyze the disease progression risk factors for ICU patients with severe pneumonia. Results: The MODS score, C reactive protein and fasting blood glucose in the improvement group on admission were significantly lower than in the deterioration group (all P<0.05). The length of ICU stay, antibiotic application time, mechanical ventilation and indwelling catheter proportion in the improvement group were significantly reduced as compared with those in the deterioration group (all P<0.05). At 3rd day and 7th day after admission and before remission, the CHE level in the improvement group was significantly higher, and the PCT level and APACHE II scores were significantly lower than on admission (P<0.05). At 3rd day and 7th day after admission and before remission, the CHE level in the deterioration group was significantly lower, and the PCT level and APACHE II scores were significantly higher than on admission (P<0.05). On admission, after admission (24h, 3rd day, 7th day) and before remission, the CHE level in the improvement group was significantly higher, the PCT level and APACHE II scores were significantly lower than in the deterioration group (P<0.05). The serum CHE level was negatively correlated with APACHE II score (r=-0.531, P<0.05), the serum PCT level was positively correlated with APACHE II score (r=0.725, P<0.05), and the serum CHE level was negatively correlated with PCT (r=-0.564, P<0.05). The APACHE II score, MODS score, CHE, PCT, C reactive protein, fasting blood glucose and mechanical ventilation were independent risk factors for ICU patients with severe pneumonia (P<0.05). Conclusion: The decrease of serum CHE level and the increase of PCT level in ICU patients with severe pneumonia are independent risk factors for the deterioration of ICU patients with severe pneumonia. The dynamic monitoring of serum CHE and PCT levels is helpful for the assessment of the prognosis of ICU patients with severe pneumonia.