血清S-ChE、PAB、ApoA1及APACHEⅡ评分对重症肺炎预后的评估[摘要]目的探讨血清胆碱酯酶（S-ChE）、前白蛋白（PAB）、载脂蛋白A1（ApoA1）及急性生理学与慢性健康状况系统Ⅱ（APACHEⅡ）评分对重症肺炎预后的评估作用方法选择2015年3月至2017年3月我院接诊的70例重症肺炎患者作为本研究对象，根据APACHEⅡ评分＜20分为A组，APACHEⅡ评分≥20分为B组，比较两组多器官功能障碍综合征（MODS）发生率及死亡率；根据是否发生MODS分为MODS组和非MODS组，根据28d后转归情况分为死亡组和存活组，比较组间血清S-ChE、PAB、ApoA1及APACHEⅡ评分的差异。结果A组MODS发生率、死亡率均明显低于B组[17.24%（5/29）vs43.90%（18/41），10.34%（3/29）vs41.46%（17/41）]（P＜0.05）；MODS组血清S-ChE、PAB、ApoA1明显低于非MODS组[（2.84±0.33）kU/Lvs（4.53±0.40）kU/L，（118.45±15.20）mg/Lvs（204.61±17.92）mg/L，（0.60±0.11）g/Lvs（1.15±0.21）g/L]，APACHEⅡ评分明显高于非MODS组[（26.91±2.74）分vs（19.58±2.04）分]，比较均具有显著差异（P＜0.05）；死亡组血清S-ChE、PAB、ApoA1明显低于存活组[（2.75±0.31）kU/Lvs（4.46±0.29）kU/L，（109.86±15.73）mg/Lvs（184.51±16.85）mg/L，（0.59±0.12）g/Lvs（1.12±0.18）g/L]，APACHEⅡ评分明显高于存活组[（28.95±2.40）分vs（18.58±1.97）分]，比较均具有显著差异（P＜0.05）；Logistic回归分析结果中显示，S-ChE、PAB、ApoA1、APACHEⅡ评分均是影响重症肺炎预后的独立危险因素（OR=0.082、0.137、0.096、1.798，P均＜0.05）。结论血清S-ChE、PAB、ApoA1及APACHEⅡ评分对重症肺炎预后均具有良好的评估价值。【关键词】重症肺炎；胆碱酯酶；前白蛋白；载脂蛋白A1；急性生理学与慢性健康状况系统Ⅱ评分EvaluationofprognosisofseverepneumoniabyserumS-ChE,PAB,ApoA1andAPACHEIIscore[Abstract]ObjectiveTostudytheevaluationofprognosisofseverepneumoniabyserumcholinesterase(S-ChE),prealbumin(PAB),apolipoproteinA1(ApoA1)andAcutephysiologyandchronichealthscoringsystemII(APACHEII)score.Methods70patientsofseverepneumoniawhoreceivedtherapyfromMarch2015toMarch2017inourhospitalwereselectedasresearchobjects.AccordingtotheAPACHEscore＜20dividedintoAgroup,APACHEscore≥20weredividedintoBgroup,theincidenceofmultipleorgandysfunctionsyndrome(MODS)andmortalitywerecomparedbetweenthetwogroups;dependingonwhetherMODSoccurreddividedintoMODSandnonMODSgroups,accordingtotheprognosisafter28d,thepatientsweredividedintothedeathgroupandthesurvivalgroup,thedifferencesofserumS-ChE,PAB,ApoA1andAPACHEIIscoresbetweenthetwogroupswerecompared.ResultsTheincidenceoftheMODSandmortalityinAgroupweresignificantlylowerthanthoseingroupB[17.24%(5/29)vs43.90%(18/41),10.34%(3/29)vs41.46%(17/41)](P＜0.05);theserumS-ChE,PAB,ApoA1inMODSgroupweresignificantlylowerthanthoseinnonMODSgroup[(2.84±0.33)kU/Lvs(4.53±0.40)kU/L,(118.45±15.20)mg/Lvs(204.61±17.92)mg/L,(0.60±0.11)g/Lvs(1.15±0.21)g/L],theAPACHEscorewashigherthanthoseinnonMODSgroup[(26.91±2.74)scorevs(19.58±2.04)score],thedifferencewasstatisticallysignificant(P＜0.05);theserumS-ChE,PAB,ApoA1indeathgroupweresignificantlylowerthanthoseinsurvivalgroup[(2.75±0.31)kU/Lvs(4.46±0.29)kU/L,(109.86±15.73)mg/Lvs(184.51±16.85)mg/L,(0.59±0.12)g/Lvs(1.12±0.18)g/L],theAPACHEscorewashigherthanthoseinsurvivalgroup[(28.95±2.40)scorevs(18.58±1.97)score],thedifferencewasstatisticallysignificant(P＜0.05);theLogisticregressionanalysisshowedthatthescoresofS-ChE,PAB,Apo,A1andAPACHEIIwereindependentriskfactorsfortheprognosisofseverepneumonia(OR=0.082,0.137,0.096,1.798,Pall＜0.05).ConclusionTheserumS-ChE,PAB,ApoA1andAPACHEIIscoreshaveagoodevaluationvalueinthep...
