吸入性肺炎相关危险因素及支气管肺泡灌洗液淀粉酶对其诊断价值的研究

发布时间：2018-03-19 23:03

本文选题：吸入性肺炎　切入点：生物学标志物　出处：《兰州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨气管插管患者吸入性肺炎的相关危险因素及支气管肺泡灌洗液α-淀粉酶是否可作为其诊断的生物学标志物。方法：1.ICU气管插管患者吸入性肺炎相关危险因素的研究采用前瞻性研究方法,纳入2013年10月至2014年12月间入住兰州大学第二医院重症监护二科气管插管患者为研究对象,排除入住前一周内确诊肺炎患者,记录符合纳入标准患者基本临床特征及存在的误吸危险因素并根据是否符合以下标准；1.存在误吸危险因素；2.插管72小时内(排除呼吸机相关性肺炎)符合肺炎诊断标准,将所有患者分为吸入性肺炎组与无吸入性肺炎组,比较两组患者临床基本特征、误吸危险因素等方面的差异,并应用多元logistic回归分析吸入性肺炎发生的相关危险因素及其相关性。2.纤维支气管镜肺泡灌洗液(BALF)α-淀粉酶诊断吸入性肺炎的阈值及其敏感性、特异性对所有符合纳入标准患者行纤维支气管镜肺泡灌洗,送检BALFα-淀粉酶活性测定,细菌、真菌培养,菌种鉴别,并送检同一时间段血α-淀粉酶、PCT检测。根据患者是否存在吸入性肺炎分为吸入性肺炎组和无吸入性肺炎组。绘制受试者工作特征曲线(ROC曲线),计算曲线下面积,评估BALFα-淀粉酶活性是否可作为诊断吸入性肺炎的生物学标志物及其诊断阂值与敏感性、特异性。结果：1.符合纳入标准患者68例,9例中途退出该研究,最终纳入研究59例。其中吸入性肺炎患者25例(42.4%),BALFα-淀粉酶活性平均值721.7士1384.6(U/L),无吸入性肺炎患者34例(57.6%),BALFα-淀粉酶活性平均值258.5±525.8(U/L),吸入性肺炎组BALFa-淀粉酶活性高于无吸入性肺炎组BALFα-淀粉酶活性,两组之间淀粉酶活性水平差异存在统计学意义(P0.05)。绘制ROC曲线,BALFα-淀粉酶活性对吸入性肺炎诊断的曲线下面积(AUC)为0.787(95%置信区间0.671-0.903),其最佳诊断阈值105.7U/L,敏感度0.960,特异性0.618。2.误吸主要危险因素包括意识障碍,呛咳、吞咽困难,管饲,呕吐,误吸危险因素越多,BALFα-淀粉酶活性水平越高,吸入性肺炎的发病率也越高。误吸危险因素数≥3个患者的BALFα-淀粉酶活性水平高于≤2个患者的BALFα-淀粉酶活性水平,差异具有统计学意义(1532.6±2187.2U/L、562.3±927.9U/L VS 97.4∧18.0U/L、43.6±15.6U/L,P0.05);误吸危险因素数≥3个患者的吸入性肺炎发病率高于≤2个患者的吸入性肺炎发病率,差异具有统计学意义(83.3±%、 53.1% VS 21.4%、0%,P0.05)。3.通过单因素分析得出,性别、年龄、体重、血α-淀粉酶活性水平、血PCT水平在吸入性肺炎组和无吸入性肺炎组之间差异无统计学意义(P0.05)。APACHE Ⅱ评分、意识障碍、呛咳吞咽困难、管饲、呕吐在两组之间差异具有统计学意义(P0.05)。单因素分析后,对P0.05的影响因素采用多元logistic回归分析：吸入性肺炎发生的危险因素包括意识障碍(P=0.000,OR=1.71,95%置信区间1.07-2.64)、呛咳吞咽困难(P=0.040,OR=3.929,95%置信区间1.063-14.525)、呕吐(P=0.047,OR=3.975,95%置信区间1.020-15.491)。4.59份BALF标本行细菌真菌培养,培养阴性37例(62.7%),阳性22例(37.3%),其中鲍曼不动杆菌8例(36.4%),肺炎克雷伯杆菌5例(22.7%),金黄色葡萄球菌4例(18.2%),大肠埃希菌3例(13.6%),阴沟肠杆菌1例(4.5%),铜绿假单胞菌1例(4.5%)。结论：意识障碍,呛咳、吞咽困难、呕吐是气管插管患者吸入性肺炎发生的危险因素,BALFα-淀粉酶可作为吸入性肺炎诊断的生物学标志物,其诊断阈值为105.7U/L。
[Abstract]:Objective: To investigate the risk of aspiration pneumonia in patients with tracheal intubation and bronchoalveolar lavage fluid of alpha amylase is as its diagnostic biomarkers. Methods: To study the related risk factors of 1.ICU inhalation pneumonia patients with tracheal intubation by using the prospective study method in October 2013 to December 2014 in Second Hospital Affiliated to Lanzhou University, two ICU intubation patients as the research object, in the week before a diagnosis of pneumonia patients met the inclusion criteria were excluded, recorded the basic clinical features and the risk factors of aspiration and according to whether they meet the following criteria; 1. had aspiration risk factors; 2. intubation within 72 hours (excluding ventilator-associated pneumonia) in accordance with the diagnostic criteria of pneumonia, all patients were divided aspiration pneumonia group and non pneumonia group, compared two groups of patients with clinical characteristics, risk of aspiration The differences and other factors, and the application of multivariate logistic regression analysis of aspiration pneumonia related risk factors and the correlation between.2. of bronchoalveolar lavage fluid (BALF) alpha amylase inhalation pneumonia diagnosis threshold and the sensitivity and specificity of all met the inclusion criteria underwent bronchoalveolar lavage, determination of - amylase activity for BALF a bacterial, fungal culture and strain identification, and send the same time of blood amylase, PCT detection. According to whether the patient had aspiration pneumonia were divided into aspiration pneumonia group and non pneumonia group. The receiver operating characteristic curve (ROC curve), calculate the area under the curve, BALF whether the activity of alpha amylase can be used as a diagnostic biomarker of aspiration pneumonia and its diagnostic threshold and sensitivity, specificity. Results: 68 patients met the inclusion criteria of 1. patients, 9 cases of reneging In this study, the final study in 59 cases. 25 cases of pneumonia in patients with BALF (42.4%), the alpha amylase activity average 721.7 + 1384.6 (U/L), no aspiration pneumonia in 34 patients (57.6%), BALF alpha amylase activity average of 258.5 + 525.8 (U/L), inhalation pneumonia group BALFa- the activity of amylase was higher than non - amylase activity inhalation pneumonia group BALF alpha amylase activity level, significant differences between the two groups (P0.05). There are ROC curves of BALF alpha - amylase activity of inhalation pneumonia diagnosis area under the curve (AUC) was 0.787 (95% confidence interval 0.671-0.903), the best diagnostic threshold of 105.7U/L 0.960, the sensitivity, specificity of 0.618.2. aspiration of the main risk factors include disturbance of consciousness, cough, difficulty swallowing, tube feeding, vomiting, aspiration of the more risk factors, the level of BALF alpha amylase activity is higher, the incidence of inhalation lung inflammation is also higher. The number of risk factors of aspiration More than 3 of patients with BALF levels of alpha amylase activity was higher than the level of 2 patients with BALF of alpha amylase activity, the difference was statistically significant (1532.6 + 2187.2U/L, 562.3 + 927.9U/L VS 97.4 ^ 43.6 + 15.6U/L, 18.0U/L, P0.05); the number of risk factors of aspiration more than 3 patients with aspiration pneumonia incidence is the incidence of aspiration pneumonia in 2 patients, the difference was statistically significant (83.3 +% 53.1%, VS 21.4%, P0.05 0%,.3.) by single factor analysis showed that gender, age, body weight, serum amylase activity and serum PCT level in inhalation group and no difference between inflammatory inhalation pneumonia group had no statistical significance (P0.05).APACHE score, disturbance of consciousness, cough dysphagia, vomiting tube feeding, the difference was statistically significant between the two groups (P0.05). Single factor analysis, the affecting factors of P0.05 by using multiple logistic regression analysis: aspiration pneumonia hair The risk factors include disorders of consciousness (P=0.000, OR=1.71,95% CI 1.07-2.64), cough dysphagia (P=0.040, OR=3.929,95% CI 1.063-14.525), vomiting (P=0.047, OR=3.975,95% CI 1.020-15.491).4.59 BALF specimens for bacterial and fungal culture, culture negative in 37 cases (62.7%), 22 cases were positive (37.3%), which Bauman Acinetobacter in 8 cases (36.4%), 5 cases of Klebsiella pneumoniae (22.7%), 4 cases of Staphylococcus aureus (18.2%), 3 cases of Escherichia coli (13.6%), 1 cases of Enterobacter cloacae (4.5%), 1 cases of Pseudomonas aeruginosa (4.5%). Conclusion: disturbance of consciousness cough, dysphagia, vomiting is a risk factor for pneumonia inhalation endotracheal intubation in patients with BALF, alpha amylase can be used as a biological marker for diagnosis of aspiration pneumonia, the diagnostic threshold is 105.7U/L.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R563.1

【相似文献】