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-  2016 

高迁移率族蛋白1预测呼吸机相关性肺炎患者近期死亡率的价值

DOI: doi:10.7507/1671-6205.2016130

Keywords: 呼吸机相关性肺炎, 预后, 高迁移率族蛋白1, 全身感染性相关器官功能衰竭评分

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Abstract:

目的探讨高迁移率族蛋白1(HMGB1)对呼吸机相关性肺炎(VAP)患者近期死亡率的预测价值。 方法纳入2013年3月至2015年3月延安大学附属医院呼吸内科重症监护室中符合VAP诊断标准的患者118例, 依据28 d是否发生死亡分为死亡组和生存组。分析两组间基础资料, 以及诊断后第1、4和7 d的HMGB1、C反应蛋白(CRP)、临床肺部感染评分(CPIS)、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、全身感染性相关器官功能衰竭评分(SOFA)等指标的差异, 通过单因素和多因素分析筛选预测VAP近期死亡的危险因素, 通过受试者工作特征(ROC)曲线分析危险因素预测近期死亡率的准确性。 结果存活组87例, 死亡组31例。死亡组和生存组之间年龄、性别、体重指数, 以及各时间点的HMGB1水平、APACHEⅡ和SOFA评分等指标比较, 差异有统计学意义( P<0.05)。单因素分析显示第4 d的HMGB1( P=0.031)、APACHEⅡ( P=0.018)和SOFA评分( P=0.048), 第7 d的HMGB1( P=0.087)、APACHEⅡ( P=0.073)和SOFA评分( P=0.049)与VAP患者28 d死亡密切相关。多因素分析显示第4 d的HMGB1( HR=1.43, 95% CI 1.07~1.78, P=0.021), 第4 d的SOFA评分( HR=1.15, 95% CI 1.06~1.21, P=0.019)和第7 d的HMGB1( HR=1.27, 95% CI 1.18~1.40, P=0.003)是预测VAP患者近期死亡的独立危险因素。ROC曲线分析显示第4 d的HMGB1>51.2 μg/L (敏感性92.7%, 特异性81.9%), 第4 d的SOFA评分>7.9(敏感性68.9%, 特异性71.0%), 第7 d的HMGB1>47.5 μg/L (敏感性73.2%, 特异性88.2%)是预测VAP患者28 d死亡的理想阈值。 结论HMGB1是一种可有效预测VAP近期死亡率的新指标

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