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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2021年02期

页码:

164-168

栏目:

论著

出版日期:

2021-04-20

文章信息/Info

Title:

Study on the risk factors of ARDS in patients with pneumonia complicated with hypoxemia

作者:

刘士琛¹ 王美菊¹ 刘 刚¹ 刘双林¹ 徐 静¹ 徐卿甲² 于 鸿² 李 琦¹

400037 重庆,陆军(第三)军医大学第二附属医院呼吸与危重症医学科·全军呼吸内科研究所¹ 400038 重庆,陆军(第三)军医大学基础医学学院²

Author(s):

Liu Shichen¹;  Wang Meiju¹;  Liu Gang¹;  Liu Shuanglin¹;  Xu Jing¹;  Xu Qingjia²;  Yu Hong²;  Li Qi¹.

¹Institute of Respiratory Diseases, Pulmonary and Critical Care Medicine, Xinqiao Hospital, Army Medical University, Chongqing 400037, China; ²College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China

关键词:

肺炎;  低氧血症;  急性呼吸窘迫综合征;  危险因素

Keywords:

Pneumonia;  Hypoxemia;  Acute respiratory distress syndrome;  Risk factors

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2021.02.006

摘要:

目的 探究肺炎合并低氧血症患者进展为ARDS的早期危险因素。方法 回顾性病例对照研究,选取2016年1月1日至2019年12月30日陆军军医大学新桥医院收治的64例肺炎合并低氧血症患者作为研究对象,根据患者是否发展为ARDS分为ARDS病例组32例和对照组32例。收集两组患者发生肺炎合并低氧血症时的性别、年龄、合并症、手术、生命体征、实验室检查、急性生理学和慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、肺炎严重程度评分(PSI)、肺损伤预测评分(LIPS)等临床资料,采用单因素分析、二元Logistic回归方法,分析ARDS发生的早期危险因素。绘制受试者工作特征曲线(ROC),评估各指标的预测价值。结果 单因素分析显示:呼吸次数(Z=-2.18,P=0.03)、脉搏(Z=-2.70,P=0.01)、AST(Z=-2.14,P=0.03)、ALT(Z=-1.96,P<0.05)、PaO₂/FiO₂(t=-3.43,P=0.00)、LIPS(Z=-3.87,P=0.00),两组间差异有统计学意义(P<0.05); 多因素Logistic回归分析中LIPS评分(OR=2.24,95%CI:1.32～3.81)、100 mmHg<PaO₂/FiO₂≤200 mmHg(OR=6.55,95%CI: 1.40～30.68)、PaO₂/FiO₂≤100 mmHg(OR=14.29,95%CI:1.05～194.41)为发生ARDS的独立危险因素; ROC曲线分析显示,LIPS、PaO₂/FiO₂均可预测肺炎合并低氧血症患者发生ARDS,LIPS的AUC为0.78(P<0.01),阈值为4分,敏感度为72.0%,特异度为72.0%,阳性预测价值为72.0%; PaO₂/FiO₂的AUC为0.73(P<0.01),阈值为182.90 mmHg,敏感度为59.0%,特异度为81.0%,阳性预测价值为67.0%。两者联合预测时,AUC为0.83(P<0.01),敏感度为72.0%,特异度为81.0%。结论 LIPS、PaO₂/FiO₂是肺炎合并低氧血症患者进展为ARDS的独立危险因素,LIPS≥4分、PaO₂/FiO₂≤182.90 mmHg患者发生ARDS的风险显著升高。两者联合预测ARDS发生的价值较单一指标更优。

Abstract:

Objective To explore the early risk factors of ARDS in patients with pneumonia complicated with hypoxemia. Methods In a retrospective case-control study, 64 patients with pneumonia complicated with hypoxemia treated in Xin qiao Hospital of the third military Medical University from January 1, 2016 to December 30, 2019 were divided into ARDS case group 32 and control group 32 according to whether the patients developed into ARDS. The clinical data of sex, age, complications, surgery, vital signs, laboratory examination, acute physiology and chronic health score Ⅱ(APACHE Ⅱ), pneumonia severity score(PSI)and lung injury prediction score(LIPS)were collected from the two groups of patients with pneumonia complicated with hypoxemia. Univariate analysis and binary logistic regression were used to analyze the early risk factors of ARDS. Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of each index. Results Univariate analysis showed: respiratory frequency(Z=-2.18, P=0.03), pulse(Z=-2.70, P=0.01), AST(Z=-2.14, P=0.03), ALT(Z=-1.96, P<0.05), PaO₂/FiO₂(t=-3.43, P=0.00), LIPS(Z=-3.87, P=0.00), the difference between the two groups was statistically significant(P<0.05); in the multivariate logistic regression analysis, LIPS Score(OR=2.24, 95%CI:1.32-3.81),100 mmHg<PaO₂/FiO₂≤200 mmHg(OR=6.55, 95%CI: 1.40-30.68), and PaO₂/FiO₂≤100 mmHg(OR=14.29, 95%CI:1.05-194.41)were independent risk factors for the occurrence of ARDS; ROC curve analysis showed that both LIPS and PaO₂/FiO₂ could predict the occurrence of ARDS in patients with pneumonia and hypoxemia. The AUC of LIPS was 0.78(P<0.01), and the threshold was 4 points, the sensitivity was 72.0%, the specificity was 72.0%, and the positive predictive value was 72.0%; The AUC of PaO₂/FiO₂ was 0.73(P<0.01), the threshold was 182.90 mmHg, the sensitivity was 59.0%, the specificity was 81.0%, and the positive predictive value was 67.0%. When the both were jointly predicted, the AUC was 0.83(P<0.01), the sensitivity was 72.0%, and the specificity was 81.0%. Conclusion LIPS and PaO₂/FiO₂ were independent risk factors for the progression of ARDS in patients with pneumonia complicated with hypoxemia. Patients with LIPS≥4 points and PaO₂/FiO₂≤182.90 mmHg had a significantly higher risk of ARDS. The combined prediction of ARDS was better than a single index.

参考文献/References:

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备注/Memo

备注/Memo:

通信作者: 李 琦, Email: liqioliver@sina.com

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更新日期/Last Update: 2021-04-20