血清S-ChE、PAB、Apo A1及APACHEⅡ评分对重症肺炎预后的评估

血清S-ChE、PAB、Apo A1及APACHEⅡ评分对重症肺炎预后的评估(论文4800字)
[摘要]目的 探讨血清胆碱酯酶（S-ChE）、前白蛋白（PAB）、载脂蛋白A1（Apo A1）及急性生理学与慢性健康状况系统Ⅱ（APACHEⅡ）评分对重症肺炎预后的评估作用方法 选择2015年3月至2017年3月我院接诊的70例重症肺炎患者作为本研究对象，根据APACHEⅡ评分＜20分为A组，APACHEⅡ评分≥20分为B组，比较两组多器官功能障碍综合征（MODS）发生率及死亡率；根据是否发生MODS分为MODS组和非MODS组，根据28d后转归情况分为死亡组和存活组，比较组间血清S-ChE、PAB、Apo A1及APACHEⅡ评分的差异。结果 A组MODS发生率、死亡率均明显低于B组[17.24%（5/29）vs43.90%（18/41），10.34%（3/29）vs41.46%（17/41）]（P＜0.05）；MODS组血清S-ChE、PAB、Apo A1明显低于非MODS组[（2.84±0.33）kU/L vs（4.53±0.40）kU/L，（118.45±15.20）mg/L vs（204.61±17.92）mg/L，（0.60±0.11）g/L vs（1.15±0.21）g/L]，APACHEⅡ评分明显高于非MODS组[（26.91±2.74）分vs（19.58±2.04）分]，比较均具有显著差异（P＜0.05）；死亡组血清S-ChE、PAB、Apo A1明显低于存活组[（2.75±0.31）kU/L vs（4.46±0.29）kU/L，（109.86±15.73）mg/L vs（184.51±16.85）mg/L，（0.59±0.12）g/L vs（1.12±0.18）g/L]，APACHEⅡ评分明显高于存活组[（28.95±2.40）分vs（18.58±1.97）分]，比较均具有显著差异（P＜0.05）；Logistic回归分析结果中显示，S-ChE、PAB、Apo A1、APACHEⅡ评分均是影响重症肺炎预后的独立危险因素（OR=0.082、0.137、0.096、1.798，P均＜0.05）。结论 血清S-ChE、PAB、Apo A1及APACHEⅡ评分对重症肺炎预后均具有良好的评估价值。
【关键词】重症肺炎；胆碱酯酶；前白蛋白；载脂蛋白A1；急性生理学与慢性健康状况系统Ⅱ评分
Evaluation of prognosis of severe pneumonia by serum S-ChE, PAB, Apo A1 and APACHE II score
[Abstract] Objective To study the evaluation of prognosis of severe pneumonia by serum cholinesterase(S-ChE), prealbumin(PAB), apolipoprotein A1(Apo A1) and Acute physiology and chronic health scoring system II (APACHE II) score. Methods 70 patients of severe pneumonia who received therapy from March 2015 to March 2017 in our hospital were selected as research objects. According to the APACHE score＜20 divided into A group, APACHE score≥20 were divided into B group, the incidence of multiple organ dysfunction syndrome (MODS) and mortality were compared between the two groups; depending on whether MODS occurred divided into MODS and non MODS groups, according to the prognosis after 28d, the patients were divided into the death group and the survival group, the differences of serum S-ChE, PAB, Apo A1 and APACHE II scores between the two groups were compared. Results The incidence of the MODS and mortality in Agroup were significantly lower than those in group B[17.24%(5/29)vs43.90%(18/41), 10.34%(3/29)vs41.46%(17/41)] (P＜0.05); the serum S-ChE, PAB, Apo A1 in MODS group were significantly lower than those in non MODS group[(2.84±0.33)kU/L vs(4.53±0.40)kU/L, (118.45±15.20)mg/L vs(204.61±17.92)mg/L, (0.60±0.11)g/L vs(1.15±0.21)g/L], the APACHE score was higher than those in non MODS group[(26.91±2.74)score vs(19.58±2.04)score], the difference was statistically significant(P＜0.05); the serum S-ChE, PAB, Apo A1 in death group were significantly lower than those in survival group[(2.75±0.31)kU/L vs(4.46±0.29)kU/L, (109.86±15.73)mg/L vs(184.51±16.85)mg/L, (0.59±0.12)g/L vs(1.12±0.18)g/L],the APACHE score was higher than those in survival group[(28.95±2.40) score vs(18.58±1.97) score], the difference was statistically significant(P＜0.05); the Logistic regression analysis showed that the scores of S-ChE, PAB, Apo, A1 and APACHE II were independent risk factors for the prognosis of severe pneumonia(OR=0.082, 0.137, 0.096, 1.798, Pall＜0.05). Conclusion The serum S-ChE, PAB, Apo A1 and APACHE II scores have a good evaluation value in the prognosis of severe pneumonia.
Key words: Severe pneumonia; Cholinesterase; Prealbumin; Apolipoprotein A1; Acute physiology and chronic health scoring system II score