摘要
目的:探讨血清可溶性髓系细胞触发受体-1(sTREM-1)、降钙素原(PCT)与乳酸水平对重症肺炎患者短期预后的预测价值。方法:选取2021年10月至2022年12月金华市人民医院确诊重症肺炎患者共198例为研究对象,根据治疗28 d后临床结局分为存活组153例和死亡组45例。比较2组患者临床资料(性别、年龄、入院APACHE II和SOFA评分、脓毒性休克)和血生化指标(入院时刻和治疗7 d后),主要包括sTREM-1、PCT、乳酸、中性粒细胞与淋巴细胞比值(NLR)、血肌酐和尿素氮、C反应蛋白(CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和血小板与淋巴细胞比值(PLR)。采用多因素Logistic回归筛选影响因素,Spearman相关分析相关性,受试者工作特征(ROC)曲线计算曲线下面积(AUC)和最佳临界值,Kaplan-Meier曲线绘制累积生存率。结果:死亡组患者入院APACHE Ⅱ、SOFA评分和脓毒性休克比例、sTREM-1、PCT、乳酸、NLR、血肌酐和尿素氮、CRP、IL-8和TNF-α显著升高,而PLR显著下降(P<0.05)。多因素Logistic回归分析显示,APACHE Ⅱ评分、sTREM-1、PCT和乳酸升高与重症肺炎28 d死亡密切相关(P<0.05)。Spearman相关分析显示,APACHE Ⅱ评分与sTREM-1、PCT和乳酸水平呈显著正相关(r=0.620、0.595和0.521,P<0.05)。ROC曲线分析显示,sTREM-1、PCT和乳酸预测死亡的AUC分别为0.801、0.698和0.745,sTREM-1和乳酸联合预测死亡的AUC为0.899,临界值分别为sTREM-1≥35.6 mmol/L和乳酸≥1.68 mmol/L。最后,将198例患者分为高风险组59例(sTREM-1≥35.6 mmol/L且乳酸≥1.68 mmol/L)、中风险组50例(sTREM-1≥35.6 mmol/L或者乳酸≥1.68 mmol/L)和低风险组89例(sTREM-1<35.6 mmol/L且乳酸<1.68 mmol/L),Kaplan-Meier曲线显示高风险组累积存活率最低(P<0.05)。结论:重症肺炎入院早期检测sTREM-1、PCT和乳酸对评估治疗28 d短期临床结局具有重要价值,sTREM-1和乳酸联合预测死亡的价值最高,sTREM-1≥35.6 mmol/L和乳酸≥1.68 mmol/L是重要的临界值。
Objective:To explore the value of serum soluble trigger receptor expressed myeloid cell-1(sTREM-1),procalcitonin(PCT)and lactate levels in evaluating the short-term prognosis of patients with severe pneumonia.Methods:A total of 198 patients with severe pneumonia confirmed in Jinhua People’s Hospital from October 2021 to December 2022 were included.According to the clinical outcome after 28 days of treatment,they were divided as the survival group(n=153)and the death group(n=45).The clinical data(gender,age,admission APACHE Ⅱ and SOFA scores,proportion of septic shock)and blood biochemistry(admission time and 7 days after treatment)including sTREM-1,PCT,lactate,neutrophil to lymphocyte ratio(NLR),blood creatinine and urea nitrogen,C-reactive protein(CRP),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),platelet to lymphocyte ratio(PLR)were compared.Multivariate Logistic regression was used to screen influencing factors,Spearman correlation analysis to analyze correlation,receiver operator characteristic curve(ROC)to calculate area under curve(AUC)and optimal critical value,Kaplan-Meier curve to plot cumulative survival rate.Results:The scores of APACHE Ⅱ and SOFA,septic shock,sTREM-1,PCT,lactic acid,NLR,serum creatinine and urea nitrogen,CRP,IL-8 and TNF-α admission in the death group were significantly higher than in the survival group,while PLR was significantly decreased(P<0.05).Multivariate Logistic regression showed that the higher APACHE Ⅱ score and increased sTREM-1,PCT and lactic acid were closely related to the 28-day death of severe pneumonia(P<0.05).Spearman correlation analysis showed that APACHE Ⅱ score was significantly positively correlated with sTREM-1,PCT and lactate levels(r=0.620,0.595 and 0.521,P<0.05).ROC showed AUC of sTREM-1,PCT and lactic acid for predicting death was 0.801,0.698 and 0.745 respectively.AUC of sTREM-1 combined with lactic acid for predicting death was 0.899,with the cut-off value of sTREM-1≥35.6 mmol/L and lactic acid≥1.68 mmol/L,respectively.A total of 198 patients were divided into high-risk group(n=59,sTREM-1≥35.6 mmol/L and lactic acid≥1.68 mmol/L),medium-risk group(n=50,sTREM-1≥35.6 mmol/L or lactic acid≥1.68 mmol/L)and low-risk group(n=89,sTREM-1<35.6 mmol/L and lactic acid<1.68 mmol/L).The Kaplan-Meier survival curve showed that cumulative survival rate of high-risk group was the lowest(P<0.05).Conclusion:Early detection of sTREM-1,PCT and lactic acid for severe pneumonia is of great value in evaluating clinical outcome after 28-day treatment.sTREM-1 combined with lactic acid is the most valuable in predicting death,and sTREM-1≥35.6 mmol/L and lactic acid≥1.68 mmol/L are critical values.
作者
傅顺金
廖岐鸣
金剑敏
FU Shunjin;LIAO Qiming;JINJianmin(Department of Emergency,Jinhua People’s Hospital,Jinhua 321000,China;Blood Permeable Purification Center,Jinhua People’s Hospital,Jinhua 321000,China)
出处
《温州医科大学学报》
CAS
2023年第9期734-739,共6页
Journal of Wenzhou Medical University
基金
金华市公益性技术应用研究项目(2022-4-167)。
关键词
重症肺炎
可溶性髓系细胞触发受体-1
降钙素原
乳酸
预后
severe pneumonia
soluble trigger receptor expressed myeloid cell-1
procalcitonin
lactic acid
prognosis
