摘要
目的:分析肺部超声评分(LUS)联合CT定量指标对重症监护病房(ICU)重症肺炎患者病情严重程度和预后的评估价值。方法:本研究为病例对照研究,采用目的抽样的方法纳入2020年9月至2023年9月陕西省第五人民医院收治的119例ICU重症肺炎患者作为重症肺炎组,另选择100例同期普通肺炎患者作为普通肺炎组。所有患者接受肺部超声、胸部CT检查。比较重症肺炎组与普通肺炎组的性别、年龄、感染类型、基础疾病、CURB-65评分、LUS、CT定量指标[病变体积(LV)、病变区域平均密度(MLD)、病变区域肺质量(LQ)]。根据CURB-65评分不同将119例ICU重症肺炎患者分为3分组(33例)、4分组(58例)、5分组(28例)。比较普通肺炎组、3分组、4分组、5分组的LUS和CT定量指标。根据患者28 d内是否死亡将119例ICU重症肺炎患者分为死亡组(31例)和存活组(88例),比较2组患者性别、年龄、病程、病变部位、基础疾病、住院时间、合并症、LUS、CT定量指标。采用logistic回归分析影响ICU重症肺炎患者预后的影响因素。采用受试者操作特征曲线分析LUS、LV、LQ和三者联合检测预测ICU重症肺炎患者28 d内死亡的价值。结果:重症肺炎组中男73例,女46例,年龄(63.38±10.25)岁,年龄范围43~84岁;普通肺炎组中男58例,女42例,年龄(62.50±10.42)岁,年龄范围44~84岁。重症肺炎组CURB-65评分较普通肺炎组高[(4.03±0.32)分比(2.71±0.69)分],差异有统计学意义(t=18.63,P<0.001);2组患者在性别、年龄、感染类型和基础疾病方面差异均无统计学意义(均P>0.05)。重症肺炎组LUS、LV、MLD、LQ均较普通肺炎组高,差异均有统计学意义(均P<0.001)。3分组、4分组、5分组LUS、LV、MLD、LQ均较普通肺炎组高,4分组、5分组LUS、LV、MLD、LQ均较3分组高,5分组LUS、LV、MLD、LQ较4分组高,差异均有统计学意义(均P<0.05)。与存活组相比,死亡组年龄更大[(67.05±10.42)岁比(59.71±10.33)岁],LUS更高[(20.96±2.73)分比(16.77±1.71)分],LV更大[(52.89±8.57)ml比(40.00±8.95)ml],MLD更高[(-135.03±46.17)HU比(-222.59±60.11)HU],LQ更重[(58.71±6.37)g比(47.53±7.01)g](均P<0.001)。死亡组和存活组在性别、病程、病变部位、基础疾病、住院时间和合并症方面比较差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示LUS增大、LV增大、LQ增大是ICU重症肺炎患者死亡的独立危险因素。受试者工作特征曲线分析显示LUS、LV、LQ和三者联合检测预测ICU重症肺炎患者28 d内死亡的曲线下面积分别为0.774、0.720、0.766、0.831。三者联合预测ICU重症肺炎患者28 d内死亡的敏感度、特异度分别为81.55%、64.10%。结论:LUS、LV、LQ与ICU重症肺炎患者病情严重程度和预后密切相关,三者联合检测可作为预测ICU重症肺炎患者预后的重要手段。
Objective To analyze the value of the lung ultrasound score(LUS)combined with quantitative parameters of computer tomography(CT)in evaluating disease severity and prognosis of severe pneumonia in intensive care unit(ICU).Methods This was a case-control study.Using the objective sampling method,119 patients with severe pneumonia admitted to ICU of the Fifth People's Hospital of Shaanxi Province from September 2020 to September 2023 were selected as the severe pneumonia group.Meanwhile,100 patients with common pneumonia were selected as the common pneumonia group.All patients received lung ultrasound and chest CT examinations.Gender,age,infection type,underlying disease,CURB-65(Confusion,Urea>7 mmol·L-1,Respiratory rate≥30·min-1,low Blood pressure,and age≥65 yrs)score,LUS,and quantitative parameters of CT like lesion volume(LV),mean lesion density(MLD)and lung quality(LQ)of the lesion region were compared between groups.According to the CURB-65 score,119 patients with severe pneumonia in ICU were divided into 3-point group(33 cases),4-point group(58 cases)and 5-point group(28 cases).LUS and quantitative parameters of CT were compared among the common pneumonia group,3-point group,4-point group and 5-point group.According to 28-day survival,119 patients with severe pneumonia in ICU were divided into death group(31 cases)and survival group(88 cases).The gender,age,course of disease,lesion location,underlying disease,length of stay,comorbidity,LUS,and quantitative parameters of CT were compared.Logistic regression analysis was conducted to identify the prognostic factors for patients with severe pneumonia in ICU.The value of LUS,LV,LQ,and their combination in predicting 28-day mortality of severe pneumonia in ICU was analyzed using receiver operating characteristic(ROC)curves.Results In the severe pneumonia group,there were 73 male cases and 46 female cases,with a mean age of(63.38±10.25[43-84])years.In the common pneumonia group,there were 58 male cases and 42 female cases,with a mean age of(62.50±10.42[44-84])years.The CURB-65 score of the severe pneumonia group was significantly higher than that of the common pneumonia group([4.03±0.32]points vs[2.71±0.69]points,t=18.63,P<0.001).There were no significant differences between the two groups in the gender,age,infection type,and underlying disease(P>0.001).LUS,LV,MLD and LQ in the severe pneumonia group were significantly higher than those of the common pneumonia group(all P<0.05).LUS,LV,LQ and MLD in 3-point group,4-point group and 5-point group were significantly higher than those of the common pneumonia group.LUS,LV,MLD and LQ in 4-point group and 5-point group were significantly higher than those of 3-point group.LUS,LV,MLD and LQ of 5-point group were significantly higher than those of 4-point group(all P<0.05).Compared with those of the survival group,patients in the death group had a significantly older age([67.05±10.42]years vs[59.71±10.33]years),higher LUS([20.96±2.73]points vs[16.77±1.71]points),larger LV([52.89±8.57]ml vs[40.00±8.95]ml),higher MLD([-135.03±46.17]HU vs[-222.59±60.11]HU)and larger LQ([58.71±6.37]g vs[47.53±7.01]g)(all P<0.001).There were no significant differences between the death group and the survival group in the gender,course of disease,lesion location,underlying disease,length of stay,and complications(all P>0.05).Multivariate logistic regression analysis results showed that increased LUS,LV and LQ were independent risk factors for the prognosis of severe pneumonia in ICU.ROC curve analysis showed that the areas under the curve(AUC)of LUS,LV,LQ,and their combination in predicting 28-day mortality of severe pneumonia in ICU was 0.774,0.720,0.766,and 0.831,respectively.The sensitivity and specificity of the combination of the three indicators in predicting the 28-day mortality of severe pneumonia in ICU were 81.55%and 64.10%,respectively.Conclusions LUS,LV and LQ are closely related to disease severity and prognosis of severe pneumonia in ICU.Combined detection of the three indicators can be used as an important approach to predict the prognosis of severe pneumonia in ICU.
作者
惠立本
高瑜
仵倩红
解建毅
张蕾
吴键
周子涵
袁颖
张斌
张俊娥
王立
巩佩
Hui Liben;Gao Yu;Wu Qianhong;Xie Jianyi;Zhang Lei;Wu Jian;Zhou Zihan;Yuan Ying;Zhang Bin;Zhang Jun'e;Wang Li;Gong Pei(Department of Functional Medicine,Tuberculosis Hospital of Shaanxi Province,the Fifth People's Hospital of Shaanxi Province,Xi'an 710100,China;Department of Critical Care Medicine,Tuberculosis Hospital of Shaanxi Province,the Fifth People's Hospital of Shaanxi Province,Xi'an 710100,China;Department of Medical Imaging,Tuberculosis Hospital of Shaanxi Province,the Fifth People's Hospital of Shaanxi Province,Xi'an 710100,China)
出处
《国际呼吸杂志》
2024年第8期907-913,共7页
International Journal of Respiration
作者简介
通信作者:巩佩,Email:gong.pei@163.com。
