CD5L及PaCO_2检测在重症哮喘机械通气患者预后判断中的应用研究

目的探讨血清CD5抗原样蛋白(CD5L)、动脉血PaCO_2检测对重症哮喘机械通气患者院内生存的预测价值。方法选择2013年1月至2016年1月本院收治的重症哮喘机械通气患者38例,采用急性生理学和慢性健康评分Ⅱ(APACHEⅡ)在患者入院24h内进行病情评估,采用酶联免疫吸附法在患者入院时及入院治疗6h检测血清CD5L水平,同时检测动脉血二氧化碳分压(PaCO_2)水平。采用Pearson相关分析法分析APACHEⅡ评分与CD5L、PaCO_2水平的相关性;采用受试者工作特征曲线(ROC曲线)评估血清CD5L及PaCO_2对重症哮喘机械通气患者院内生存的预测价值。结果重症哮喘机械通气死亡患者APACHEⅡ评分高于存活患者(P0.05);死亡患者治疗后CD5L水平低于存活患者,但PaCO_2水平高于存活患者(P0.05)。APACHEⅡ评分与CD5L水平呈负相关(r=-0.347,P0.05),与PaCO_2水平呈正相关(r=0.573,P0.05)。ROC曲线分析结果显示,CD5L、PaCO_2对重症哮喘机械通气患者院内生存的预测价值良好,CD5L的预测灵敏度为93.33%、特异度为75.00%、准确度为89.47%、阳性预测值为93.33%、阴性预测值75.00%,PaCO_2的预测灵敏度为90.00%、特异度为87.50%、准确度为89.47%、阳性预测值为97.42%、阴性预测值70.00%。结论重症哮喘机械通气患者血清CD5L水平越低,PaCO_2水平越高,病情越严重,预后越差。CD5L、PaCO_2检测对重症哮喘机械通气患者院内生存的预测价值良好。

Value of CD5L and PaCO2 in predicting the survival of patients with severe asthma and mechanical ventilation

Objective To investigate the value of CD5 molecule-like protein(CD5L) and partial pressure of CO2 in arterial blood(PaCO2) in predicting the survival of patients with severe asthma and mechanical ventilation.Methods From Jan.2013 to Jan.2016,a total of 38 patients with severe asthma and mechanical ventilation were enrolled.Acute Physiology and Chronic Health EvaluationⅡ(APACHE II)were used to assess the severity.Enzyme linked immunosorbent assay was used to detect serum levels of CD5L at admission and 6 h after treatment.PaCO2 were also detected.Pearson correlation analysis was used to analyze the correlation between APACHEⅡ score and CD5L and PaCO2 levels.Receiver operation characteristic(ROC) curve was used to evaluate the value of CD5L and PaCO2 in predicting the survival of patients.Results APACHEⅡscores of survival patients were significantly higher than dead patients(P<0.05).CD5L level of survival patients after treatment was significantly lower than dead patients,while PaCO2 level was significantly higher(P<0.05).APACHEⅡ score was negatively correlated with serum CD5L level(r=-0.347,P<0.05),while positively correlated with PaCO2 level(r=0.573,P<0.05).ROC curve analysis showed that serum CD5L and PaCO2 were with predictive value for prediction the survival of patients,with sensitivity of 93.33%,specificity of 75.00%,accuracy of 89.47%,positive predictive value of 93.33%,and negative predictive value of 75.00% for CD5L,and those for PaCO2 were 90.00%,87.50%,89.47%,97.42% and 70.00%.Conclusion With the decreasing of CD5L level and increasing of PaCO2 level,severity of disease in patients with severe asthma and mechanical ventilation could be more serious condition,indicating poor prognosis.CD5L and PaCO2 could be with fine predictive value of survival of patients with severe asthma and mechanical ventilation.