血清降钙素原、和肽素、胆碱酯酶对颅脑损伤后机械通气并发肺部感染患者预后的预测效能

Predictive efficacy of serum procalcitonin, copeptin, and cholinesterase for the prognosis of patients with craniocerebral injury complicated by pulmonary infections after mechanical ventilation

摘要:

目的 分析颅脑损伤后机械通气并发肺部感染患者血清降钙素原（PCT）、和肽素、胆碱酯酶（CHE）水平与预后的关系。方法 选取2020年12月—2023年12月常宁市人民医院收治的行机械通气的颅脑损伤伴肺部感染患者70例为感染组，另取同期该院82例单纯颅脑损伤患者为未感染组，并将感染组患者按28 d生存情况分为存活组（48例）和死亡组（22例），比较各组患者血清PCT、和肽素、CHE水平，采用单因素分析及多因素一般Logistic回归模型分析颅脑损伤后机械通气并发肺部感染患者死亡的危险因素，绘制受试者工作特征（ROC）曲线评价血清PCT、和肽素、CHE对颅脑损伤后机械通气并发肺部感染患者死亡的预测价值。结果 感染组患者血清PCT、和肽素水平高于未感染组（P <0.05），CHE水平低于未感染组（P <0.05）。存活组和死亡组患者第1秒用力呼气量与用力肺活量比值（FEV₁/FVC）、血清PCT、和肽素、CHE、格拉斯哥昏迷评分（GCS）、临床肺部感染评分（CPIS）、急性生理学及既往健康状况评分Ⅱ（APACHE Ⅱ）比较，差异均有统计学意义（P<0.05）。多因素一般Logistic回归分析结果显示：血清PCT ［O^R=1.531（95% CI：1.059，2.213）］、和肽素［O^R=2.132（95% CI：1.161，3.914）］、CHE ［O^R=3.251（95% CI：1.383，7.641）］、CPIS评分［O^R=4.860（95% CI：2.210，10.686）］及APACHE Ⅱ评分［O^R=2.901（95% CI：1.327，6.341）］是颅脑损伤后机械通气并发肺部感染患者死亡的独立危险因素（P <0.05）。ROC曲线结果显示，PCT、和肽素、CHE预测颅脑损伤后机械通气并发肺部感染患者死亡的敏感性分别为68.2%、68.2%和77.3%，特异性分别为66.7%、64.6%和70.8%，曲线下面积（AUC）分别为0.754、0.749和0.853；3者联合预测的敏感性为90.9%，特异性为62.5%，AUC为0.904，联合检测预测价值较高。结论 联合检测血清PCT、和肽素、CHE水平对颅脑损伤后机械通气并发肺部感染患者预后有着良好的预测价值。

Abstract:

Objective To explore the relationship between levels of serum procalcitonin (PCT), copeptin and cholinesterase (CHE) and the prognosis of patients with craniocerebral injury complicated by pulmonary infections after mechanical ventilation.Methods The 70 patients with craniocerebral injury complicated by pulmonary infections who were admitted to Changning People's Hospital for mechanical ventilation from December 2020 to December 2023 were selected as the infected group, and 82 patients with only craniocerebral injury in the hospital during the same period were included in the uninfected group. Patients in the infected group were divided into the survival group (n = 48) and the death group (n = 22) according to the 28-day survival status. The levels of serum PCT, copeptin and CHE were compared among the groups. Univariate analysis and multivariate Logistic regression analysis were performed to identify the risk factors affecting the death of patients with craniocerebral injury complicated by pulmonary infections after mechanical ventilation. Receiver operating characteristic (ROC) curve was plotted to assess the predictive values of serum PCT, copeptin and CHE for the death of patients with craniocerebral injury complicated by pulmonary infections after mechanical ventilation.Results The levels of serum PCT and copeptin in the infected group were higher than those in the uninfected group (P < 0.05), while the level of CHE in the infected group was lower than that in the uninfected group (P < 0.05). There were statistically significant differences in the forced expiratory volume in one second/forced vital capacity (FEV₁/FVC), serum levels of PCT, copeptin, and CHE, the Glasgow coma scale (GCS) score, the clinical pulmonary infection score (CPIS) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score between the survival group and death group (P < 0.05). Multivariate Logistic regression analysis showed that higher levels of serum PCT [O^R = 1.531 (95% CI: 1.059, 2.213) ], copeptin [O^R = 2.132 (95% CI: 1.161, 3.914) ], and CHE [O^R = 3.251 (95% CI: 1.383, 7.641) ], and higher CPIS scores [O^R = 4.860 (95% CI: 2.210, 10.686) ] and APACHE II scores [O^R = 2.901 (95% CI: 1.327, 6.341) ] were independent risk factors affecting the death of patients with craniocerebral injury complicated by pulmonary infections after mechanical ventilation (P < 0.05). ROC curve analysis indicated that the sensitivities of PCT, copeptin and CHE in predicting the death of patients with craniocerebral injury complicated by pulmonary infections after mechanical ventilation were 68.20%, 68.20% and 77.30%, with the specificities being 66.70%, 64.60% and 70.80%, and the areas under the curves (AUC) being 0.754, 0.749 and 0.853. The sensitivity, specificity and AUC of the combined prediction of the three indicators were 90.90%, 62.50% and 0.904, respectively, indicating a high predictive value.Conclusion The combined detection of serum levels of PCT, copeptin and CHE has a good predictive value for the prognosis of patients with craniocerebral injury complicated by pulmonary infections after mechanical ventilation..