摘要
目的探讨早期血液炎症指标对重症社区获得性肺炎导致呼吸衰竭的预后评估价值。方法选择入院诊断为重症肺炎导致呼吸衰竭的186例患者为研究对象。根据患者预后分为死亡组42例、好转组144例。分析患者入院后2 d细胞因子12项、铁蛋白、CRP、降钙素原、血常规、血气分析结果,收集患者肺炎严重程度指数(PSI)及急性生理学和慢性健康状况(APACHEⅡ)评分,研究上述指标与患者预后的相关性。结果与好转组患者相比,死亡组患者入院时的血IFN-γ、IL-10、IL-6、IL-8、CRP、降钙素原和铁蛋白水平均较高(P均<0.05)。死亡组入院时血常规中血红蛋白、血小板低于好转组患者(P均<0.05)。死亡组入院时PSI评分、APACHEⅡ评分高于好转组,同时死亡组血气分析中乳酸水平较高,OI较低(P均<0.05)。多因素Logistic回归分析显示,IL-6、铁蛋白、PSI、乳酸水平和APACHEⅡ评分是预后不良的危险因素,血小板水平是预后不良的保护因素(P均<0.05)。受试者操作特征(ROC)曲线提示IL-6、降钙素原和铁蛋白对患者预后有良好的预测作用,当IL-6和铁蛋白分别超过11.41 ng/L和659μg/L,血小板低于148.5×109/L时,患者有死亡风险。结论在重症社区肺炎导致呼吸衰竭患者中,血液炎症指标IL-6、铁蛋白、降钙素原升高提示患者死亡风险高。特别是IL-6超过11.41 ng/L、铁蛋白超过659μg/L、血小板低于148.5×109/L的患者,临床工作中应重点关注该类患者,降低其死亡风险。
Objective To evaluate the prognostic value of early blood inflammatory indicators in patients with respiratory failure caused by severe community-acquired pneumonia.Methods A total of 186 patients diagnosed with respiratory failure due to severe pneumonia on admission were recruited in this study.According to clinical prognosis,they were divided into the death group(n=42)and improvement group(n=144).Twelve cytokines,ferritin,C-reactive protein,procalcitonin,blood routine examination and blood gas analysis results of the patients within two days after admission were analyzed.Pneumonia severity index(PSI)and APACHEⅡscores of the patients were collected.The correlation between the above indicators and prognosis was explored.Results Compared with the improvement group,the levels of IFN-γ,IL-10,IL-6,IL-8,C-reactive protein(CRP),procalcitonin and ferritin were significantly higher in the death group(all P<0.05).Upon admission,the hemoglobin level and platelet count in the death group were significantly lower than those in the improvement group(both P<0.05).The PSI and APACHEⅡscores on admission in the death group were significantly higher compared with those in the improvement group(both P<0.05).Patients in the death group had higher lactic acid level and lower oxygenation index(OI)compared with their counterparts in the improvement group(both P<0.05).Multivariate Logistic regression analysis revealed that IL-6,ferritin,PSI and APACHEⅡscores and lactic acid level were the risk factors for poor prognosis,whereas platelet count was the protective factor for poor prognosis(all P<0.05).The receiver operating characteristic(ROC)curve indicated that IL-6,procalcitonin and ferritin were favorable predictors for clinical prognosis of patients.When IL-6 and ferritin levels exceed 11.41 ng/L and 659μg/L,and platelet count was less than 148.5×109/L,patients were at risk of death.Conclusions In patients with respiratory failure caused by severe community-acquired pneumonia,the increase of blood inflammatory indicators,such as IL-6,ferritin and procalcitonin,suggests high risk death in patients,especially for patients with IL-6>11.41 ng/L,ferritin>659μg/L,and platelet count<148.5×109/L.Extensive attention should be paid to lowering the risk of death in these patients.
作者
孙世瑜
朱淼
李田田
王海波
左华芹
王薛洁
Sun Shiyu;Zhu Miao;Li Tiantian;Wang Haibo;Zuo Huaqin;Wang Xuejie(Department of Emergency,Clinical Medicine College of Yangzhou University,Northern Jiangsu People’s Hospital,Yangzhou 225001,China)
出处
《新医学》
CAS
2024年第3期198-203,共6页
Journal of New Medicine
基金
江苏省自然科学基金(BK20190908)
苏北人民医院院基金(yzucms202036)。
关键词
炎症指标
细胞因子
铁蛋白
重症肺炎
呼吸衰竭
预后
Inflammatory index
Cytokines
Ferritin
Severe pneumonia
Respiratory failure
Prognosis
