中文摘要：

目的探讨血浆D-二聚体及纤维蛋白原（FIB）评估社区获得性肺炎（CAP）患者病情严重程度及预后的价值。方法回顾性分析福建医科大学附属第-医院收治的成人CAP住院患者的临床资料，根据肺炎严重指数（PSI）分级将患者分为Ⅰ～Ⅴ级组，根据30d预后将患者分为死亡组和存活组。比较各组患者性别、年龄、PSI评分、血小板计数（PLT）、白细胞计数（WBC）、D-二聚体、FIB、C-反应蛋白（CRP）等数据；采用Spearman或Pearson相关分析PSI评分与D-二聚体、CRP和FIB的相关性；绘制受试者工作特征曲线（ROC），分析各指标对患者预后的预测价值。结果499例CAP患者中男性298例，女性201例；年龄（63．4±17．8）岁；PSII．V级分别为77、80、104、162、76例；30d死亡32例，病死率6．4％。PSIVI级和V级组男性多于女性，PSl分级各组间PIJT、FIB差异无统计学意义，而WBC、D-二聚体、CRP均随PSI级别增高而显著升高（E=3．810、X22=102．361、F3=7．070，均P〈0．01）o与存活组比较，死亡组年龄较大（t=-4．773、P〈0．001），PLT降低（t=3．026、P=0．003），WBC、PSI评分、D-二聚体、CRP水平明显升高（t1=-2．545、t2=-8．421、Z3=-6．947、t4=-3．770，均P〈0．05）。另外，老年（≥65岁）患者血浆D-二聚体水平明显高于中青年（〈65岁）患者（Z=-5．338，P〈0．01）。相关性分析显示，PSI评分与D-二聚体、CRP均呈显著正相关（r值分别为0．475、O．260，均P〈0．001），而与FIB无相关性（r=-0．062，P=0．170）。PSI评分、D-二聚体、CRP单独预测死亡风险的ROC曲线下面积（AUC）分别为0．858[95％可信区间（95％CD=0．802～0．914]、0．867（95％CI=0．812～0．922）、0．732（95％CI=0．641～0．823），PSI评分联合D-二聚体预测死亡风险的AUC提升至0．905（95％CI=0．867—0．944），均P〈0．001。PSI截断值〉122分预测死亡风险的敏感?

英文摘要：

Objective To investigate the utility of plasma D-dimer and fibrinogen （FIB） for the severity assessments and predicting the prognosis of patients with community-acquired pneumonia （CAP）. Methods The clinical data of patients with CAP admitted to First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. The patients were divided into I - V level groups according to pneumonia severity index （PSI）, and they were divided into non-survivors and survivors according to 30-day prognosis. The data including gender, age, PSI score, platelets count （PLT）, white blood cell count （WBC）, D-dimer, FIB, and C-reactive protein （CRP） were compared among groups. The correlations between PSI score and D-dimer, CRP as well as FIB were analyzed by Spearman or Pearson correlation analysis. Receiver operating characteristic curve （ROC） was used to assess the prognostic value of these indicators. Results A total of 499 patients with CAP were enrolled with 298 male and 201 female, the average age was （63.4 ± 17.8） years old, and the 30-day mortality was 6.4% （32/499）. There were 77, 80, 104, 162 and 76 patients in PSI Ⅰ～Ⅴ level groups, and there were more male patients in PSI VI and V level groups. There were no significant differences in PLT and FIB among the groups of different PSI levels, but the levels of WBC, D-dimer and CRP were significantly increased as PSI level increased from I to V （F1 = 3.810, x22 = 102.361, F3 = 7.070, all P 〈 0.01）. Compared with survivors, the non-survivors were elder （t = -4.773, P 〈 0.001） with lower PLT （t = 3.026, P = 0.003） and higher WBC, PSI score, D-dimer and CRP levels （t1 = -2.545, t2 = -8.421, Z3 = -6.947, t4 = -3.770, all P 〈 0.05）. Plasma D-dimer levels in elderly patients （〉1 65 years old） were statistically higher than those in younger patients （〈 65 years old; Z = -5.338, P 〈 0.01）. It was shown by correlation analysis that PSI score was positively correlated with D-dimer and CRP （r v