可溶性尿激酶型纤溶酶原激活物受体联合降钙素原检测在呼吸机相关性肺炎早期诊断及预后判断中的价值

摘要

目的 探讨可溶性尿激酶型纤溶酶原激活物受体(su PAR)联合降钙素原(PCT)检测在呼吸机相关性肺炎(VAP)早期诊断及预后判断中的价值.方法 选取60例VAP患者(观察组)根据不同预后情况分为存活组32例与死亡组28例,同期选择30例行机械通气治疗而未出现VAP的患者设为对照组.采用酶联免疫吸附法(ELISA)检测观察组及对照组患者机械通气前后血清su-PAR、PCT表达水平,同时检测死亡组和存活组治疗第1、3、5、7天时血清su-PAR、PCT表达水平,采用受试者工作特征(ROC)曲线法分析血清su-PAR联合PCT诊断VAP和预测VAP患者生存情况的价值.结果 2组机械通气前以及对照组机械通气前后血清su-PAR、PCT表达水平比较,差异均无统计学意义(P＞ 0.05),观察组机械通气后血清su-PAR、PCT表达水平显著高于机械通气前及对照组机械通气后(P ＜0.05);死亡组治疗第1、3、5、7天时的血清su-PAR、PCT表达水平显著高于存活组(P ＜0.05),且随治疗时间的延长而显著升高(P ＜0.05),存活组则在治疗第5天达到高峰,而第7天显著降低(P ＜0.05);血清su-PAR联合PCT早期诊断VAP和预测VAP患者生存情况的价值均优于单一指标检测.结论血清su-PAR联合PCT检测在VAP早期诊断及预后判断中具有较高的应用价值.%Objective To investigate the value of soluble urokinase plasminogen activator receptor (su PAR) combined with procalcitonin (PCT) detection in early diagnosis and prognosis of ventilator-associated pneumonia (VAP). Methods A total of 60 patients with VAP (observation group) were divided into survival group (n = 32) and death group (28) according to the different prognosis. At the same period, 30 patients with mechanical ventilation without VAP were selected as the control group. The expression levels of serum su-PAR and PCT of the observation group and control group before and after mechanical ventilation were detected by using enzyme-linked immunosorbent (ELISA). At the same time, their levels in the survival group and death group at the 1, 3, 5, 7 days after treatment were also detected. The value of serum su-PAR combined with PCT detection in diagnosis and predicting survival of patients were analyzed by the receiver-operating characteristic curve (ROC). Results There were no significant differences in the levels of serum su-PAR and PCT between the two groups before mechanical ventilation and in the control group before and after mechanical ventilation (P＞ 0. 05). The expression levels of serum su-PAR and PCT of the observation group after mechanical ventilation were significantly higher than those of before mechanical ventilation and the control group after mechanical ventilation (P ＜ 0. 05). The expression levels of serum suPAR and PCT of the death group at 1, 3, 5 and 7 day of the treatment were significantly higher than those of the survival group (P ＜ 0. 05), and their levels were significantly higher with the time extension of the treatment (P ＜ 0. 05). Meanwhile, their expression levels of survival group reached a peak on the 5 th day of treatment, while decreased significantly on the 7 th day (P ＜ 0. 05). The value of serum su-PAR combined with PCT in the early diagnosis of VAP and the prediction of VAP patient survival was better than that of single indicator detection. Conclusion The detection of serum su-PAR combined with PCT has a high value in early diagnosis and prognosis of VAP.