PSI和CURB-65评分对艾滋病和非艾滋病社区获得性肺炎患者预后的临床评估价值

Clinical value of PSI and CURB-65 scores in assessing prognosis of community-acquired pneumonia in AIDS and non-AIDS patients

摘要:

目的 探讨肺炎严重指数（PSI）和英国胸科协会改良肺炎评分（CURB-65）对艾滋病和非艾滋病患者社区获得性肺炎（CAP）预后的临床评估价值。方法 回顾性分析2015年10月—2018年8月柳州市人民医院288例艾滋病CAP患者（A组）和201例非艾滋病CAP患者（B组）的临床资料。记录所有患者入院后24 h内的相关资料，根据临床预后将A组患者分为好转组和恶化组，将B组患者同样也分为好转组和恶化组。计算患者PSI和CURB-65评分，绘制受试者工作特征（ROC）曲线分析这两种评分系统的预测能力。结果 好转组和恶化组的PSI和CURB-65评分比较，差异均有统计学意义（P <0.05）；艾滋病CAP患者PSI和CURB-65评分的ROC曲线下面积（AUC）分别为0.672（95% CI：0.599，0.744）、0.603（95% CI：0.522，0.684），差异无统计学意义（P >0.05）。非艾滋病CAP患者PSI和CURB-65评分的AUC分别为0.863（95% CI：0.775，0.950）、0.848（95%CI：0.777，0.920），差异无统计学意义（P >0.05）。结论 PSI和CURB-65评分系统能准确预测非艾滋病CAP患者的预后状况，适于临床推广应用；对于艾滋病CAP患者，单独应用这两种评分的预测效果均不佳。

Abstract:

Objective To study the clinical value of PSI and CURB-65 scores in assessing the prognosis of community-acquired pneumonia (CAP) in AIDS and Non-AIDS patients.Methods Totally 288 CAP patients with AIDS (group A) and 201 CAP patients with Non-AIDS (group B) were retrospectively analyzed. Relevant clinical data within 24 hours after admission were recorded. According to the prognosis, the patients were divided into improvement group and deterioration group. The PSI score and CRUB-65 scores were calculated according to the clinical data. The predictive ability of the two scoring systems was analyzed by receiver operator characteristic (ROC) curve.Results There were significant differences in PSI and CRUB-65 scores between deterioration group and improvement group in group A and B (P < 0.05). In group B, the AUC of the PSI and CURB-65 scores was 0.863 (95% CI: 0.775, 0.950) and 0.848 (95% CI: 0.777, 0.920). There was no significant difference between PSI and CURB-65 score (P > 0.05). In group A, the area under curve (AUC) of the PSI and CURB-65 scores were 0.672 (95% CI: 0.599, 0.744) and 0.603 (95% CI: 0.522, 0.684). There was no significant difference between PSI and CURB-65 score (P > 0.05).Conclusion The PSI and CURB -65 score systems can more accurately predict the prognosis of CAP patients with non-AIDS, which is suitable for clinical application. However, these two score systems are not suitable for the community-acquired pneumonia patients with AIDS.