摘要
目的探讨重症肺炎(SP)患者血浆可溶性髓系细胞触发受体-1(sTREM-1)、可溶性fms样酪氨酸激酶受体-1(sFLT-1)及超氧化物歧化酶(SOD)水平变化及临床意义。方法选取海口市第三人民医院(2018年1月至2019年1月)收治的150例肺炎患者,根据病情程度分为普通肺炎组(n=63)和SP组(n=87),治疗后随访28 d,根据是否死亡将SP组分为死亡组(n=32)和存活组(n=55),另选取同期60名体检健康者为对照组。对比各组血浆sTREM-1、sFLT-1、SOD水平,多因素Logistics回归分析SP患者不良预后影响因素,ROC曲线分析血浆sTREM-1、sFLT-1、SOD水平对SP患者不良预后的预测价值。结果对照组、普通肺炎组、SP组血浆sTREM-1、sFLT-1水平逐渐提升,SOD水平逐渐降低(P<0.05)。多因素Logistics回归分析显示,重症监护室(ICU)时间(OR=1.784,95%CI 1.077~2.955)、急性生理和慢性健康评估Ⅱ(APACHEⅡ)评分(OR=1.834,95%CI 1.130~2.976)、sTREM-1(OR=1.236,95%CI 1.034~1.477)、sFLT-1(OR=1.095,95%CI 1.026~1.169)为SP患者不良预后独立危险因素,动脉血氧分压(PaO_(2))(OR=0.894,95%CI 0.809~0.988)、SOD(OR=0.933,95%CI 0.879~0.990)为保护因素(P<0.05)。ROC曲线显示,sTREM-1+sFLT-1+SOD(AUC=0.913,95%CI0.833~0.963)预测SP患者不良预后的敏感度和特异度高于sTREM-1(AUC=0.799,95%CI 0.699~0.877)、sFLT-1(AUC=0.780,95%CI 0.678~0.861)、SOD(AUC=0.801,95%CI 0.701~0.879)预测。结论SP患者血浆sTREM-1、sFLT-1水平明显提升,SOD水平明显降低,为不良预后独立影响因素,联合检测可提升不良预后预测价值。
Objective To investigate the changes and clinical significance of plasma levels of soluble myeloid cell trigger receptor-1(sTREM-1),soluble Fms-like tyrosine kinase receptor-1(sFLT-1)and superoxide dismutase(SOD)in patients with severe pneumonia(SP).Methods A total of 150 patients with pneumonia admitted to our hospital(January 2018 to January 2019)were selected and divided into normal pneumonia group(n=63)and SP group(n=87)according to their condition,follow-up for 28 days after treatment,SP was divided into death group(n=32)and survival group(n=55)according to whether or not they died,and 60 healthy people who had physical examination during the same period were selected as control group.The plasma levels of sTREM-1,sFLT-1,and SOD in each group were compared,multivariate Logistics regression was used to analyze the factors affecting the adverse prognosis of SP patients,the ROC curve analyzed the predictive value of plasma sTREM-1,sFLT-1,and SOD levels on the adverse prognosis of SP patients.Results The plasma levels of sTREM-1 and sFLT-1 in the control group,common pneumonia group and SP group gradually increased,while the SOD level gradually decreased(P<0.05).Multivariate logistic regression analysis showed that intensive care unit(ICU)time(OR=1.784,95%CI:1.077~2.955),Acute Physiology and Chronic Health AssessmentⅡ(APACHEⅡ)score(OR=1.834,95%CI:1.130~2.976),sTREM-1(OR=1.236,95%CI:1.034~1.477),s FLT-1(OR=1.095,95%CI:1.026~1.169)was an independent risk factor for poor prognosis in SP patients,arterial blood oxygen pressure(PaO_(2))(OR=0.894,95%CI:0.809~0.988),SOD(OR=0.933,95%CI:0.879~0.990)was a protective factor(P<0.05).The ROC curve showed that the sensitivity and specificity of s TREm-1+sFLT-1+SOD(AUC=0.913,95%CI:0.833~0.963)in predicting the poor prognosis of SP patients were higher than those of sTREm-1(AUC=0.799,95%CI:0.699~0.877),sFLT-1(AUC=0.780,95%CI:0.678~0.861),and SOD(AUC=0.801,95%CI:0.701~0.879).Conclusions Plasma sTREM-1 and sFLT-1 levels in SP patients are significantly increased,and SOD levels are significantly reduced.These are independent factors affecting poor prognosis.Combined detection can increase the predictive value of poor prognosis.
作者
符征高
陈钰
梁勇
许俊旭
吴挺实
郝金香
FU Zheng-gao;CHEN Yu;LIANG Yong;XU Jun-xu;WU Ting-shi;HAO Jin-xiang(Dept,of Respiratory Critical Illness Medicine,Haikou Third People fs Hospital,Haikou Hainan 571100,China)
出处
《昆明医科大学学报》
CAS
2021年第10期132-138,共7页
Journal of Kunming Medical University
基金
海南省自然科学基金资助项目(818QN318)。
