【作者】 陆芳；

【导师】 刘进；

【作者基本信息】 浙江大学 ， 内科学（呼吸病学）， 2017， 硕士

【摘要】 目的:早期快速有效的评估社区获得性肺炎(CAP)的严重程度有利于合理使用医疗资源、优化抗感染治疗和改善患者的预后。尽管已有多种方法用于临床评估,本文将研究血小板减少程度对CAP预后的影响。方法:2012年01月到2012年12月期间,对我院各病区因CAP住院的病例资料进行收集整理并回顾性分析。以CURB-65评分对患者进行严重度评分,并以30天病死率为主要终点事件,并评估血小板减少症(血小板低于10~5/μl)与CAP患者预后的关系。结果:共331例CAP患者符合条件入组,平均年龄为65±18岁;中位住院时间为9天(IQR 6-14天),30天内死亡24例(7.3%)。血小板正常或增高患者249例(84.6%);血小板减少患者共51例(15.4%),平均血小板数为73×109/L。血小板减少生存组患者为39例(12.7%),死亡组患者为12例(50%),二者具有统计学差别(P<0.001)。血小板减少程度与CAP患者的严重程度相关,通过单因素分析及多元logistic回归分析发现,血小板减少症是CAP患者30天病死率的独立危险因素(OR=5.54,95%CI1.98-15.52,P=0.001)。Kaplan-Meier 生存分析也显示血小板减少症患者具有更低的生存率。结论:血小板减少症是CAP患者30天病死率的独立危险因素,合并血小板减少症的患者具有更低的生存率。联合血小板减少症与CURB-65评分可以更好的判断CAP患者的预后。更多还原

【Abstract】 Objectives:The aim of this study was to evaluate the predictive power of thrombocytopenia for clinical outcomes in patients with community-acquired pneumonia(CAP).Methods:The data were gathered retrospectively for patients with CAP between January 2012 and December 2012 at the Second Affiliated Hospital,Zhejiang University School of Medicine.The primary end point was 30-day mortality.The predictive efficiency of thrombocytopenia was evaluated.Results:A total of 331 patients with CAP were finally eligible for analysis.The mean age was 65±18 years,the 30-day mortality were 7.3%.Thrombocytopenia were significantly different between survivors and nonsurvivors(12.7%VS 50.0%,P<0.001).Multivariate logistic regression analysis showed thrombocytopenia had a odd ratio of 5.54(95%CI 1.98-15.52,P=0.001)for 30-day mortality.And the survival analysis revealed CAP patients with thrombocytopenia showed a lower survival than the control group.Adding thrombocytopenia criteria to CURB-65 scores could significantly increased the AUC for predicting 30-day mortality(0.830 vs 0.767,P=0.029).Conclusions:Thrombocytopenia is an independent risk factor for 30-day mortality.Adding thrombocytopenia to CURB-65 scores could significantly increased the AUC for predicting 30-day mortality and ICU admission.更多还原