摘要目的 探讨血清和肽素（copeptin）、基质金属蛋白酶-9（MMP-9）及改良早期预警评分（MEWS）对老年重症肺炎（SP）患者病情评估和预后预测的价值。方法 选取我院重症监护室收治的老年SP患者308例进行前瞻性研究，检测患者血清和肽素及MMP-9水平变化，记录MEWS评分结果及患者预后情况。应用受试者工作特征（ROC）曲线分析血清和肽素、 MMP-9及MEWS评分对老年SP患者预后评估的价值。结果 死亡组MEWS评分明显高于存活组（7.22±2.78 vs. 2.60±1.65，t=8.602，P<0.05），且病死率随着MEWS评分的升高而升高。死亡组第1天、第3天及第5天血清和肽素及MMP-9水平均明显高于存活组［和肽素（pmol/L）：67.48±13.60 vs. 38.70±10.45，82.92±18.37 vs.34.61±11.50，74.60±15.36 vs. 27.18±8.30；MMP-9（ng/mL）：236.26±43.37 vs. 182.74±38.58，311.28±51.42 vs. 170.48±35.16，284.20±48.36 vs. 147.16±32.05；均P<0.05］。ROC曲线显示，第3天血清和肽素、MMP-9及MEWS评分预测SP患者死亡的最佳截断值分别为58.42 pmol/L、243.38 ng/mL和5.30分；其敏感度和特异度较好，分别为80.2%和87.8%，72.6%和80.5%，71.0%和84.8%。结论 血清和肽素、MMP-9及MEWS评分与老年SP患者的病情严重程度及预后相关，第3天血清和肽素水平能准确预测患者28 d的病死率。
陈亮，卓越，曾宗鼎，张璐璐，邢崇浩. 血清和肽素MMP-9及MEWS评分预测老年重症肺炎患者预后的价值[J]. 中国急救医学, 2018, 38(5): 390-.
Chen Liang, Zhuo Yue, Zeng Zong-ding, Zhang Lu-lu， Xing Chong-hao. Prognostic value of serum copeptin, MMP-9 and MEWS scores in patients with severe pneumonia. Chinese Journal of Critical Care Medicine, 2018, 38(5): 390-.
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