血清乳酸脱氢酶评估颅脑手术患者重症肺炎的临床价值

摘要 目的：分析血清乳酸脱氢酶在评估颅脑手术患者重症肺炎的中的应用价值。方法：选取2020年7月~2022年6月在本院神经外科进行收治的颅脑择期手术患者268例，根据是否合并术后肺炎，分为非感染组（n=185）和肺炎组（n=83），肺炎组根据肺炎严重程度分为重症肺炎31例及普通肺炎52例。采用酶联免疫吸附法测定血清PCT、CRP水平；采用酶比色法检测血清 LDH 水平，采用Pearson相关性检验分析合并肺炎患者血清LDH、PCT、CRP水平与病情严重程度的相关性。采用ROC曲线分析血清LDH、PCT、CRP水平对颅脑手术患者合并重症肺炎的临床诊断价值，血清LDH、PCT、CRP水平预估颅脑手术合并重症肺炎患者预后的价值。结果：术后1 d、3 d、7 d与未感染组对比，普通肺炎组患者血清LDH、PCT、CRP水平均明显升高（P<0.05）；与普通肺炎组对比，重症肺炎组患者血清LDH、PCT、CRP水平均明显升高（P<0.05）。经Pearson相关性检验分析，颅脑手术合并肺炎患者血清LDH、PCT、CRP水平与PSI评分呈明显正相关（P<0.05）。以术后1 d血清LDH、PCT、CRP水平建立ROC曲线，结果发现，血清LDH、PCT、CRP的曲线下面积分别为0.840、0.825、0.746。以术后7 d血清LDH、PCT、CRP水平建立ROC曲线，结果发现，血清LDH、PCT、CRP的曲线下面积分别为0.819、0.725、0.684。结论：LDH在颅脑手术合并肺炎患者中高表达，与肺炎严重程度正相关。LDH在区分非重症肺炎患者和重症肺炎患者以及预测重症肺炎患者的28天死亡率方面具有良好价值。

Clinical Value of Serum Lactate Dehydrogenase in Evaluating Severe Pneumonia in Patients Undergoing Craniocerebral Surgery

ABSTRACT Objective: To analyze the value of serum lactate dehydrogenase in evaluating severe pneumonia in patients undergoing craniocerebral surgery. Methods: 268 patients undergoing selective craniocerebral surgery in our hospital from July 2020 to June 2022 were selected. They were divided into non infection group (n=185) and pneumonia group (n=83) according to whether they were complicated with postoperative pneumonia. The pneumonia group was divided into severe pneumonia 31 cases and common pneumonia 52 cases according to the severity of pneumonia. Serum PCT and CRP levels were measured by ELISA; The serum LDH level was detected by enzyme colorimetry, and the correlation between the serum LDH, PCT, CRP levels and the severity of the disease in patients with pneumonia was analyzed by Pearson correlation test. ROC curve was used to analyze the clinical diagnostic value of serum LDH, PCT, CRP levels in patients with severe pneumonia after craniocerebral surgery, and the prognostic value of serum LDH, PCT, CRP levels in patients with severe pneumonia after craniocerebral surgery. Results: The levels of serum LDH, PCT and CRP in patients with common pneumonia were significantly higher than those in the uninfected group on the 1st, 3rd and 7th day after operation (P<0.05); Compared with the common pneumonia group, the serum LDH, PCT and CRP levels in the severe pneumonia group were significantly higher (P<0.05). Pearson correlation test showed that serum LDH, PCT, CRP levels were positively correlated with PSI scores in patients with craniocerebral surgery complicated with pneumonia (P<0.05). The ROC curve was established based on the serum LDH, PCT and CRP levels on the first day after operation. The results showed that the areas under the curve of serum LDH, PCT and CRP were 0.840, 0.825 and 0.746 respectively. The ROC curve was established based on the serum LDH, PCT and CRP levels 7 days after operation. The results showed that the areas under the curve of serum LDH, PCT and CRP were 0.819, 0.725 and 0.684 respectively. Conclusion: LDH is highly expressed in patients with craniocerebral operation complicated with pneumonia, which is positively related to the severity of pneumonia. LDH has good value in distinguishing non severe pneumonia patients from severe pneumonia patients and predicting the 28 day mortality of severe pneumonia patients.