血清前肾上腺髓质素在呼吸机相关性肺炎中的诊断价值

发布时间：2018-04-29 01:11

本文选题：前肾上腺髓质素 + 呼吸机相关性肺炎　；参考：《中国呼吸与危重监护杂志》2016年01期

【摘要】：目的探讨血清前肾上腺髓质素(pro-ADM)对呼吸机相关性肺炎(VAP)的临床诊断价值。方法前瞻性选取2014年6月至2015年7月在复旦大学附属闵行医院接受有创机械通气治疗的89例患者为研究对象,根据临床及微生物培养结果确诊有无VAP,将患者分成VAP组和非VAP组。所有患者在临床疑诊VAP第1 d、第3 d和第5 d采用双抗体夹心法测定血清中pro-ADM浓度,运用受试者工作特征曲线分析pro-ADM对VAP的诊断价值。结果在VAP疑诊第1 d、第3 d和第5 d,VAP患者的pro-ADM水平[3.10(2.21,4.61)nmol/L、3.01(2.04,4.75)nmol/L和1.85(1.12,3.54)nmol/L]高于非VAP患者[1.53(1.07,2.24)nmol/L、1.52(1.05,2.17)nmol/L和1.26(1.02,2.17)nmol/L](P0.05)。绘制受试者工作曲线计算pro-ADM在疑诊第1 d、第3 d和第5 d诊断VAP的曲线下面积分别为0.896(95%CI 0.799~0.940)、0.863(95%CI 0.791~0.935)和0.651(95%CI 0.538~0.765)。在疑诊第1 d,以2.53 nmol/L作为截断值,pro-ADM诊断VAP的敏感性和特异性分别为84.6%和86.5%;在疑诊第3 d,以2.40 nmol/L作为截断值,pro-ADM诊断VAP的敏感性和特异性分别为82.7%和83.8%。结论监测血清pro-ADM的浓度可能用于VAP的早期诊断。
[Abstract]:Objective to evaluate the clinical value of serum proadrenomedullin (pro-ADM) in the diagnosis of ventilator-associated pneumonia (VAP). Methods Eighty-nine patients who received invasive mechanical ventilation from June 2014 to July 2015 in Minhang Hospital affiliated to Fudan University were selected as study subjects. The patients were divided into VAP group and non-VAP group according to the clinical and microbial culture results. The serum pro-ADM concentration was measured by double antibody sandwich method on the 1st, 3rd and 5th day after clinical suspected VAP. The diagnostic value of pro-ADM for VAP was analyzed by using the operating characteristic curve of the subjects. Results the pro-ADM levels in patients with VAP at the 1st, 3rd and 5th day were significantly higher than those in non-VAP patients (3.102.21,4.61nmol / L 3.01nmol / L and 1.85nmol / L 1.123.54nmol / L) compared with those in non-VAP patients (1.531.072.24nmol / L = 1.05nmol / L and 1.261.02nmol / L = 2.17nmol / L). The area under the curve of pro-ADM on the 1st day, 3rd day and 5th day of suspected diagnosis was 0.896(95%CI 0.799 ~ 0.940 and 0.863 ~ 95 CI 0.7910.935) and 0.651(95%CI 0.538 ~ 0.765a respectively. The sensitivity and specificity of using 2.53 nmol/L as truncation value to diagnose VAP were 84.6% and 86.5% respectively on the first day of suspected diagnosis, and the sensitivity and specificity of pro-ADM with 2.40 nmol/L as truncation value were 82.7% and 83.8% respectively on the third day of suspected diagnosis. Conclusion Monitoring the concentration of serum pro-ADM may be used in the early diagnosis of VAP.
【作者单位】：上海交通大学医学院附属瑞金医院重症医学科;复旦大学附属闵行医院重症加强治疗病房;
【基金】：上海市闵行区科委基金(编号:2013MHZ031)
【分类号】：R563.1;R459.7

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