CURB-65、PSI、SMART-COP及APACHEⅡ评分在重症社区获得性肺炎患者早期诊断价值的比较

doi:10.3969/j.issn.1000-8535.2018.05.003

广州医药 ›› 2018, Vol. 49 ›› Issue (5): 9-12.DOI: 10.3969/j.issn.1000-8535.2018.05.003

CURB-65、PSI、SMART-COP及APACHEⅡ评分在重症社区获得性肺炎患者早期诊断价值的比较

方昌全¹, 林俊鸿¹, 李裕军², 魏树全², 赵祝香², 李晓岩², 钟维农², 赵子文²

1 惠州市中心人民医院呼吸内科(惠州 516000);
2 华南理工大学附属广州市第一人民医院呼吸内科(广州 510180)

收稿日期:2018-05-09 出版日期:2018-09-20 发布日期:2021-11-29
通讯作者: 赵子文,E-mail:zhaozw@yeah.net

Comparison of value of CURB-65、PSI、SMART-COP and APACHEⅡfor early diagnosis in patients with severe community-acquired pneumonia

FANG Changquan¹, LIN Junhong¹, LI Yujun², WEI Shuquan², ZHAO Zhuxiang², LI Xiaoyan², ZHONG Weinong², ZHAO Ziwen²

1 Department of Respiratory, Huizhou Municipal Central Hospital,Huizhou 516000, China;
2 Department of Respiratory, Guangzhou First People's Hospital Affiliated to South China University of Technology,Guangzhou 510180, China

Received:2018-05-09 Online:2018-09-20 Published:2021-11-29

摘要/Abstract

摘要： 目的探讨及比较CURB-65、PSI、SMART-COP及APACHEⅡ 4种临床评分对重症社区获得性肺炎(SCAP)患者的早期诊断价值。方法采用前瞻性研究方法,收集2011年10月—2014年2月广州市第一人民医院呼吸内科收治的67例SCAP及同期33例普通CAP患者的临床资料,记录入组后24小时内CURB-65、PSI、SMART-COP及APACHEⅡ评分的最差值,比较4种临床评分系统对SCAP的早期诊断价值。结果 SCAP组CURB-65、PSI、SMART-COP及APACHEⅡ评分均高于普通CAP组患者[CURB-65(分):3.06±1.10 比0.85±0.79,P<0.001;PSI(分):144.93±36.48比73.94±27.17,P<0.001; SMART-COP(分):6.54±1.41比 1.67±1.02,P<0.001; APACHEⅡ(分):20.79±5.69比7.94±3.87,P<0.001]。CURB-65≥3分、PSI≥130分、SMART-COP≥3分及APACHEⅡ≥15分诊断SCAP的受试者工作特征曲线(ROC)下面积(AUC)分别为0.940[95% CI:0.89~0.98, P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001],敏感度分别为65.6%、71.6%、100%、88.1%,特异度分别为100%、100%、78.7%、93.9%。结论 CURB-65及PSI评分特异度好,但敏感度低,易漏诊,SMART-COP和APACHE Ⅱ评分诊断效能更佳。

关键词: CURB-65, PSI, SMART-COP, APACHEⅡ, 社区获得性肺炎

Abstract: Objective To evaluate and compare the early diagnosis value of CURB-65,PSI,SMART-COP and APACHEⅡin patients with severe community-acquired pneumonia. Methods This was a prospective study conducted in department of respiratory in Guangzhou First People's Hospital. We included 67 SCAP patients and 33 CAP patients between October of 2011and February of 2014. The lowest scores within 24 hours of CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score,respectively,for each patients were recorded. Prediction of SCAP as made in four scoring systems was compared. Results CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score were higher in SCAP as compared with that of CAP(CURB-65:3.0±1.1 vs 0.9±0.8,P<0.001;PSI:144.6±36.4 vs 73.9±27.1,P<0.001; SMART-COP:6.5±1.4 vs 1.6±1.0,P<0.001; APACHEⅡ:20.6±5.6 vs 7.9±3.8,P<0.001). ROC curve for CURB-65 score≥ 3 scores,PSI score≥ 130 scores,SMART-COP score≥3 scores and APACHE Ⅱ score ≥ 15 scores in the early diagnosis SCAP were 0.940[95%CI:0.89~0.98,P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001]. Sensitivity of four kinds of scoring system was 65.6%,71.6%,100%,88.1%, with specificity of 100%,100%,78.7%,93.9% respectively. Conclusion The specificity of diagnosis was better in the CURB-65 and PSI score,but the sensitivity was low and easy to miss diagnosis. SMART-COP and APACHEⅡscore systems had a better diagnostic value on SCAP.

Key words: CURB-65, PSI, SMART-COP, APACHEⅡ, Community-acquired pneumonia

方昌全, 林俊鸿, 李裕军, 魏树全, 赵祝香, 李晓岩, 钟维农, 赵子文. CURB-65、PSI、SMART-COP及APACHEⅡ评分在重症社区获得性肺炎患者早期诊断价值的比较[J]. 广州医药, 2018, 49(5): 9-12.

FANG Changquan, LIN Junhong, LI Yujun, WEI Shuquan, ZHAO Zhuxiang, LI Xiaoyan, ZHONG Weinong, ZHAO Ziwen. Comparison of value of CURB-65、PSI、SMART-COP and APACHEⅡfor early diagnosis in patients with severe community-acquired pneumonia[J]. Guangzhou Medical Journal, 2018, 49(5): 9-12.

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CURB-65、PSI、SMART-COP及APACHEⅡ评分在重症社区获得性肺炎患者早期诊断价值的比较

Comparison of value of CURB-65、PSI、SMART-COP and APACHEⅡfor early diagnosis in patients with severe community-acquired pneumonia

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