PSI评分和CURB-65评分对社区获得性肺炎患者病情及预后的对比研究

但勇 覃双全

[摘要] 目的 研究PSI評分和CURB-65评分对社区获得性肺炎（CAP）患者病情及预后评估的价值。 方法 选取本院急诊留观病房2010年1～12月收治的111例CAP患者，24 h内完成相关数据采集，4周后为观察终点，预后为观测指标。对比研究两种评分系统判断CAP病情及预后的灵敏性、特异性。 结果 两种评分系统均显示低、中危组的死亡率较高危组明显降低：PSI低、高危组分别为2.7%和62.2%，CURB-65低、中、高危组分别为4.3%、16.2%、63.0%，差异有统计学意义（P < 0.05）。两种评分系统判断CAP预后的敏感性分别为92%、68%，特异性分别为83.7%、88.4%，阳性预测值分别为62.2%、63.0%，阴性预测值分别为97.3%、95.0%。 结论 PSI和CURB-65评分系统均能准确反映CAP患者的病情严重程度和判断预后，对于预测患者为“非高危”者可以认为预后良好。PSI评分的敏感性高，阴性预测值高，且评分系统相对更复杂，适合病房应用。CURB-65评分敏感性相对低，特异性高，阴性预测值高，且评分系统相对简单，有利于筛选出高危患者进行加强治疗和监护，适合在门、急诊使用。

[关键词] PSI评分；CURB-65评分；社区获得性肺炎；预后

[中图分类号] R563.1[文献标识码] A[文章编号] 1674-4721（2012）07（c）-0029-03

Clinical study between PSI and CUR-65 score in assessment of condition and prognosis in community acquired pneumonia patients.

DAN Yong Qin Shuangquan

MICU, the First People's Hospital of Changde City in Hunan Province, Changde 415000, China

[Abstract] Objective To study the valuation of PSI and CURB-65 Score in assessment of condition and prognosis in community acquired pneumonia patients. Methods Patients selected from the ICU of emergency department in the the First People's Hospital of Changde City from January to December 2010, 111 cases which were suspected of having CAP were chosen． The patients were recorded PSI and CURB-65 within 24 hours after admission． The 28th day of admission to hospital was regarded as the observation terminal and the outcomes as the observation. PSI and CURB-65 were evaluated at the sensitivity, specificity in assessment of condition and prognosis in community acquired pneumonia patients. Results The two score systems showed that the mortality of the low-risk or moderate-risk group was significantly lower than high-risk group: 2.7% vs 62.2% for PSI, 4.3% vs 16.2% vs 63.0% for CURB-65(all P < 0.05). The sensitivity were 92％ and 68％ in CAP using PSI and CURB-65, their specificity were 83.7％ and 88.4％, respectively. Their positive predictive rates were 62.2％ and 63.0％, respectively. Their negative predictive rates were 97.3％ and 95.0％，respectively. Conclusion The two score systems can accurately reflect the condition of severity and prognosis in community acquired pneumonia patients. That the prognosis is good prediction in patients with non-high-risk. The sensitivity and negative predictive rates of PSI Score are higher and more complicated than CUR-65. So PSI Score is suitable for use in ward. The sensitivity of CURB-65 is lower than PSI, but the specificity and negative predictive rates are higher than PSI． In regard to easy handle and instant filter out the patients of poor prognosis for strengthening treatment and guardianship, CURB-65 is the favorable prognostic score and suitable for use in out-patient department and emergency room.

[Key words] PSI Score; CURB-65 Score; Community acquired pneumonia; Prognosis

社区获得性肺炎（CAP）作为一种常见疾病，近年来随着社会人口老龄化、吸氧、并存基础疾病、免疫功能低下，在美国老年人（年龄大于65岁）中每年有915 900人次发生CAP[1]，同时CAP是老年人病死的主要原因之一，其病死率达15％～35％[2]。可靠的评估肺炎严重程度的方法有助于临床医生对患者进行分诊，并决定是否对患者进行密切观察和更加积极的治疗。目前国际国内评估CAP严重程度的量化评分系统有PSI、CURB-65及其衍生如CRB-65、CURB。本文对比分析本院常用的PSI评分和CURB-65评分在CAP病情及预后方面的价值，现报道如下：

1 资料与方法

1.1 一般資料

选取2010年1～12月本院急诊留观病房收治的CAP患者111例，所有CAP的诊断符合2006年中华医学会呼吸病学分会制定的《社区获得性肺炎诊断和治疗指南》上的诊断标准[3]。排除标准：（1）免疫缺陷疾病（如血液系统肿瘤或实体瘤、艾滋病）；（2）长期使用免疫抑制剂或激素治疗；（3）活动性肺结核。

1.2 方法

入选患者24 h内完成相关临床数据收集，主要包括（1）一般情况：年龄、性别、既往慢性基础疾病病史（包括糖尿病、肝脏疾病、肿瘤、慢性肾脏疾病、慢性肺部疾病、心脑血管疾病）、主要体检参数（体温、脉搏、呼吸、血压、意识）。……