【摘要】 目的 探讨老年重症耐甲氧西林金黄色葡萄球菌(MRSA)肺炎患者血清白蛋白、总蛋白水平与短期预后的关系。方法 选取2017年3月—2021年12月杭州市萧山区第一人民医院收治的老年重症MRSA肺炎患者130例进行研究，根据患者住院30 d预后结局分为存活组(73例)、死亡组(57例),收集患者性别、年龄、体质量指数(BMI)、吸烟史、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、意识障碍、呼吸衰竭、气胸资料，检测血清白蛋白、总蛋白水平并进行组间比较；采用Spearman分析老年重症MRSA肺炎患者血清白蛋白、总蛋白水平与APACHEⅡ评分之间的相关性；采用COX回归模型分析影响老年重症MRSA肺炎患者预后生存状况的因素；采用受试者工作特征(ROC)曲线分析血清白蛋白、总蛋白水平对老年重症MRSA肺炎患者预后生存的预测价值。结果 与存活组相比，死亡组年龄、APACHEⅡ评分、合并意识障碍、合并呼吸衰竭比例均较高(P<0.05),血清白蛋白、总蛋白水平均较低(P<0.05);Spearman相关分析结果显示，重症MRSA肺炎患者血清白蛋白、总蛋白水平与APACHEⅡ评分均成负相关(P<0.05);COX多因素分析结果显示，年龄>70岁、APACHEⅡ评分>16分、合并意识障碍、合并呼吸衰竭、白蛋白低表达、总蛋白低表达均是影响重症MRSA肺炎患者预后生存状况的独立危险因素(P<0.05);血清白蛋白、总蛋白水平联合预测重症MRSA肺炎患者预后生存的曲线下面积为0.917,其预测敏感度为93.20%,特异度为80.70%。结论 老年重症MRSA肺炎患者血清白蛋白、总蛋白水平与患者病情严重程度密切相关，是影响患者预后生存状况的独立危险因素，两者联合对老年重症MRSA肺炎患者预后生存有一定的预测价值，可能为评估患者病情及短期预后提供临床参考依据。更多还原

【Abstract】 Objective This paper aims to investigate the relationship between the serum levels of albumin and total protein and short-term prognosis in elderly patients with severe methicillin-resistant Staphylococcus aureus(MRSA) pneumonia. Methods A total of 130 elderly patients with severe MRSA pneumonia admitted to the First People’s Hospital of Xiaoshan District from March 2017 to December 2021 were selected for the study. According to the prognosis of 30 days in hospital, the patients were divided into survival group(73 cases) and death group(57 cases). The data of gender, age, body mass index(BMI), smoking history, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, consciousness disorder, respiratory failure and pneumothorax were collected, the levels of serum albumin and total protein were detected and compared among groups; Spearman was used to analyze the correlations between the levels of serum albumin, total protein and APACHE Ⅱ score in elderly patients with severe MRSA pneumonia; and COX regression model was used to analyze the factors influencing the survival of elderly patients with severe MRSA pneumonia. Receiver operating characteristic(ROC) curve was used to analyze the predictive value of serum albumin and total protein levels for the survival of elderly patients with severe MRSA pneumonia. Results Compared with those in the survival group, age, APACHE Ⅱ score, the proportion of consciousness disorder and respiratory failure in the death group were higher(P<0.05), and the levels of serum albumin and total protein were lower(P<0.05). Spearman correlation analysis showed that the levels of serum albumin and total protein in elderly patients with severe MRSA pneumonia was negatively correlated with APACHE Ⅱ score(P<0.05); COX multivariate analysis showed thatage>70, APACHEⅡ score>16 points, consciousness disorder, respiratory failure, low expression of albumin and low expression of total protein were independent risk factors for survival of elderly patients with severe MRSA pneumonia(P<0.05). The area under the curve of serum albumin and total protein levels in predicting the survival of elderly patients with severe MRSA pneumonia was 0.917, with the sensitivity of 93.20% and the specificity of 80.70%. Conclusion The levels of serum albumin and total protein in elderly patients with severe MRSA pneumonia are closely related to the severity of the disease. They are independent risk factors affecting the survival of patients. The combination of the two has a certain predictive value for the prognosis survival of elderly patients with severe MRSA pneumonia and may provide clinical reference for the evaluation of the disease and short-term prognosis of the patients.更多还原