耿英杰　丁伟英　国佳

[摘要] 目的 探讨血清胆碱酯酶、降钙素原与重症肺炎患者病情严重程度及预后的关系。方法 方便选取2017年1—12月入住该院的社区获得性肺炎患者197例，其中重症肺炎患者81例，普通肺炎患者116例，重症肺炎患者分为存活组和死亡组，测定血清胆碱酯酶、降钙素原与APACHEⅡ评分的关系。结果 重症肺炎组血清胆碱酯酶水平（2.51±0.71）kU/L明显低于普通肺炎组（3.40±0.39）kU/L（t=3.09，P﹤0.05），降钙素原水平（5.53±1.92）ng/mL明显高于普通肺炎组（1.02±0.65）ng/mL（t=3.98，P﹤0.05）；重癥肺炎死亡组血清胆碱酯酶水平（2.23±0.71）kU/L明显低于存活组（2.91±0.66）kU/L（t=3.05，P﹤0.05），降钙素原水平（11.42±4.17）ng/mL明显高于存活组（3.69±1.11）ng/mL（t=6.19，P﹤0.05）；重症肺炎组患者血清胆碱酯酶水平与APACHEⅡ评分呈负相关（r=-0.675，P﹤0.05），降钙素原与APACHEⅡ评分呈正相关（r=0.610，P﹤0.05）。 结论 血清胆碱酯酶、降钙素原测定对于判断重症肺炎患者病情严重程度及预后具有一定价值。

[关键词] 重症肺炎；胆碱酯酶；降钙素原；APACHEⅡ评分

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2018）06（c）-0182-03

[Abstract] Objective This paper tries to investigate the relationship between serum cholinesterase， procalcitonin and severe pneumonia in patients with severity and prognosis. Methods A total of 197 patients with community-acquired pneumonia admitted to our hospital from January to December 2017 were selected conveniently， including 81 patients with severe pneumonia and 116 patients with common pneumonia. Severe pneumonia patients were divided into survival group and death group， and serum choline was measured. The relationship between esterase， procalcitonin and APACHE II score. Results Serum cholinesterase level （2.51±0.71）kU/L was significantly lower in the severe pneumonia group than in the normal pneumonia group （3.40±0.39）kU/L （t=3.09， P<0.05）. Procalcitonin levels （5.53±1.92）ng/mL was significantly higher than that in the normal pneumonia group （1.02±0.65）ng/mL（t=3.98， P<0.05）； serum cholinesterase level in severe pneumonia group （2.23±0.71）kU/L was significantly lower than survival group （2.91±0.66）kU/L （t=3.05， P<0.05）， and procalcitonin level （11.42±4.17）ng/mL was significantly higher than survival Group（3.69±1.11）ng/mL （t=6.19， P<0.05）； Serum cholinesterase level was negatively correlated with APACHEII score in patients with severe pneumonia （r=-0.675， P<0.05）. Suyuan had positive correlation with APACHEII score（r=0.610， P<0.05）. Conclusion Serum cholinesterase and procalcitonin assay have certain value in judging the severity and prognosis of severe pneumonia patients.

[Key words] Severe pneumonia； Cholinesterase； Procalcitonin； APACHE II score

重症肺炎是ICU收治的常见疾病，起病急、进展快。易发展为急性呼吸窘迫综合征、多脏器功能障碍综合征、脓毒症休克，预后差。急性生理学和慢性健康状态评分（APACHEⅡ）是目前ICU应用最为广泛的危重病情评价系统，其对入住患者进行病情评定及预后预测，可以客观的反映病情的严重程度。该研究方便选取2017年1—12月期间入住该院呼吸内科和ICU的符合入选标准的197例社区获得性肺炎患者，通过检测入院24 h内血清胆碱酯酶（CHE）及降钙素原（PCT）的水平，分析与APACHEⅡ评分及预后的相关性，探讨血清胆碱酯酶及降钙素原水平对反映病情严重程度及预后的意义，现报道如下。……