血清S-ChE、PAB、ApoA1及APACHEⅡ评分对重症肺炎预后的评估[摘要]目的探讨血清胆碱酯酶(S-ChE)、前白蛋白(PAB)、载脂蛋白A1(ApoA1)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、ApoA1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±±±±±±0.21)g/L],APACHE±±2.04Ⅱ)分],比较均具有显著差异(P±±±±±±0.18)g/L],APACHE±±1.97Ⅱ)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、ApoA1、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、ApoA1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EvaluationofprognosisofseverepneumoniabyserumS-ChE,PAB,ApoA1andAPACHEIIscore[Abstract]ObjectiveTostudytheevaluationofprognosisofseverepneumoniabyserumcholinesterase(S-ChE),prealbumin(PAB),apolipoproteinA1(ApoA1)andAcutephysiologyandchronichealthscoringsystemII(APACHEII)score.Methods70patientsofseverepneumoniawhoreceivedtherapyfromMarch2015toMarch2017inourhospitalwereselectedasresearchobjects.AccordingtotheAPACHEscore<20dividedintoAgroup,APACHEscore≥20weredividedintoBgroup,theincidenceofmultipleorgandysfunctionsyndrome(MODS)andmortalitywerecomparedbetweenthetwogroups;dependingonwhetherMODSoccurreddividedintoMODSandnonMODSgroups,accordingtotheprognosisafter28d,thepatientsweredividedintothedeathgroupandthesurvivalgroup,thedifferencesofserumS-ChE,PAB,ApoA1andAPACHEIIscoresbetweenthetwogroupswerecompared.ResultsTheincidenceoftheMODSandmortalityinAgroupweresignificantlylowerthanthoseingroupB[17.24%(5/29)vs43.90%(18/41),10.34%(3/29)vs41.46%(17/41)](P±±±±±±±±2.04)score],thedifferencewasstatisticallysignificant(P±±±±±±±±1.97)score],thedifferencewasstatisticallysignificant(P<0.05);theLogisticregressionanalysisshowedthatthescoresofS-ChE,PAB,Apo,A1andAPACHEIIwereindependentriskfactorsfortheprognosisofseverepneumonia(OR=0.082,0.137,0.096,1.798,Pall<0.05).ConclusionTheserumS-ChE,PAB,ApoA1andAPACHEIIscoreshaveagoodevaluationvalueintheprognosisofseverepneumonia.Keywords:Severepneumonia;Cholinesterase;Prealbumin;ApolipoproteinA1;AcutephysiologyandchronichealthscoringsystemIIscore重症肺炎是临床上较为常见的呼吸系统急重症,患者通常需入住ICU,该病进展迅速、常会对多个器官造成累及,易导致感染性休克、全身炎症反应综合征(SIRS)等,严重的甚至出现多器官功能障碍综合征(MODS)等,严重影响预后[1]。较多学者认为,选择有效指标用以评估重症肺炎的病情严重程度及疾病预后中十分关键,可早期指导医师进行合理干预[2-3]。有研究称,在重症肺炎患者中,血清胆碱酯酶(S-ChE)表达呈降低状态,而在死亡患者中表达更低,但目前国内外对于该指标对重症肺炎的预后评估价值的相关报道仍较少[4]。此外,在重症肺炎的发生、发展过程中,体内较多急性时相反应蛋白均会出现明显改变,其中前白蛋白(PAB)、载脂蛋白A1(ApoA1)作为重要的急性时相蛋白指标,有助于判断疾病危重程度[5-6]。急性生理学与慢性健康状况系统Ⅱ(APACHEⅡ)评分在极危重症患者中是种应用广泛的评分标准,所得到的分数越高,则提示患者病...