社区获得性肺炎评分 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

　　[摘要] 目的 研究PSI评分和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.