摘要
目的 探究老年重症肺炎合并呼吸衰竭患者血清白蛋白(SAB)、白细胞介素-6(IL-6)、右心室Tei指数对病情严重程度及预后评估的影响.方法 将2020年1月至2022年1月内江市中医医院收治的100例老年重症肺炎合并呼吸衰竭患者纳入本次回顾性研究,并将其作为观察组,且根据病情严重程度分为低危组(n=31)、中危组(n=46)和高危组(n=23);根据患者预后生存情况又分为生存组(n=79)和死亡组(n=21);另取同期在本院接受治疗的50例老年重症肺炎患者纳入对照组.比较各分组的SAB、IL-6、右心室Tei指数;采用Pearson分析老年重症肺炎合并呼吸衰竭患者SAB、IL-6、右心室Tei指数与病情严重程度的相关性;采用受试者操作特征(ROC)曲线评估SAB、IL-6、右心室Tei指数在预测老年重症肺炎合并呼吸衰竭患者不良预后中的应用价值.结果 观察组的SAB为(28.87±5.21)g/L,显著低于对照组[(35.65±4.77)g/L],而血清 IL-6、右心室 Tei 指数分别为(40.34±6.02)pg/mL、0.51±0.07,均显著高于对照组[(19.03±4.59)pg/mL、0.35±0.06],差异均有统计学意义(P＜0.05).高危组的SAB为(25.95±3.01)g/L,均显著低于中危组[(28.64±3.78)g/L]和低危组[(30.79±3.55)g/L],而血清IL-6、右心室Tei指数分别为(46.98±5.07)pg/mL、0.56±0.05,均显著高于中危组[(40.23±5.32)pg/mL、0.51±0.06]和低危组[(35.62±5.13)pg/mL、0.43±0.05],差异均有统计学意义(P＜0.05).死亡组的SAB为(24.75±2.12)g/L,显著低于生存组[(29.01±2.25)g/L],而血清IL-6、右心室Tei指数分别为(47.68±4.91)pg/mL、0.56±0.09,均显著高于生存组[(39.08±5.60)pg/mL、0.45±0.06],差异均有统计学意义(P＜0.05).Pearson相关分析显示,患者病情严重程度与SAB呈负相关(r=-0.592,P＜0.05),而与血清IL-6、右心室Tei指数均呈正相关(r=0.546,0.506;P＜0.05).ROC曲线分析显示,SAB、IL-6、右心室Tei指数预测老年重症肺炎合并呼吸衰竭患者死亡的曲线下面积(AUC)分别为0.801、0.833、0.815,3者联合预测的AUC为0.915,优于各指标单独预测(P＜0.05).结论 SAB、血清IL-6和右心室Tei指数在老年重症肺炎合并呼吸衰竭患者中均呈现异常,且与患者病情严重情况密切相关,SAB、IL-6和右心室Tei指数联合在预测老年重症肺炎合并呼吸衰竭患者不良预后的价值较高.
Abstract
Objective To investigate the influence of serum albumin(SAB),interleukin-6(IL-6),and right ventricular Tei index on the severity and prognosis assessment of elderly severe pneumonia combined with respiratory failure patients.Methods A total of 100 elderly se-vere pneumonia patients complicated with respiratory failure admitted to Neijiang Traditional Chinese Medicine Hospital from January 2020 to Janu-ary 2022 were included in this retrospective study and were included as the observation group.The observation group was further divided into the low-risk group(n=31),the moderate-risk group(n=46),and the high-risk group(n=23)according to the severity of the condition,and were also separated into the survival group(n=79)and the death group(n=21)based on the prognosis condition.Fifty elderly severe pneumonia patients treated in the same period were included as the control group.SAB,IL-6 and right ventricular Tei index were compared.The relativity of SAB,IL-6 and right ventricular Tei index,with the severity of the disease in elderly severe pneumonia combined with respiratory fail-ure patients was evaluated by Pearson relative analysis.The predictive value of SAB,IL-6 and right ventricular Tei index in predicting adverse prognosis in elderly severe pneumonia combined with respiratory failure patients was estimated by receiver operating characteristic(ROC)curves.Results The SAB of the observation group was(28.87±5.21)g/L,which was lower than that of the control group[(35.65±4.77)g/L],while serum IL-6,left ventricular Tei index were(40.34±6.02)pg/mL and 0.51±0.07,respectively,which were higher than those in the control group[(19.03±4.59)pg/mL and 0.35±0.06],the differences were statistically significant(P＜0.05).The SAB of the high-risk group was(25.95±3.01)g/L,which was significantly lower than that of the medium risk group[(28.64±3.78)g/L]and the low-risk group[(30.79±3.55)g/L],while the serum IL-6 and right ventricular Tei index were(46.98±5.07)pg/mL and 0.56±0.05,respectively,which were significantly higher than those of the medium risk group[(40.23±5.32)pg/mL,0.51±0.06]and the low-risk group[(35.62±5.13)pg/mL,0.43±0.05],the differences were statistically significant(P＜0.05).The SAB of the death group was(24.75±2.12)g/L,which was lower than that of the survival group[(29.01±2.25)g/L],serum IL-6 and right ventricular Tei index were(47.68±4.91)pg/mL,0.56±0.09,respectively,which were higher than those of the survival group[(39.08±5.60)pg/mL,0.45±0.06],the differences were sta-tistically significant(P＜0.05).Pearson correlation analysis showed that the severity of the disease was negatively correlated with the SAB(r=-0.592,P＜0.05),while was positively correlated with the serum IL-6 and right ventricular Tei index(r=0.546,0.506;P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of SAB,IL-6 and right ventricular Tei index in predicting the death of elderly se-vere pneumonia combined with respiratory failure patients were 0.801,0.833,0.815,respectively.The AUC of the three indicators combined prediction was 0.915,much higher than that of individual indicator prediction(P＜0.05).Conclusion SAB,serum IL-6,and right ventric-ular Tei index all show abnormalities in elderly patients with severe pneumonia combined with respiratory failure,and are closely related to the se-verity of the disease.The combination of SAB,IL-6,and right ventricular Tei index has a high value in predicting adverse prognosis in elderly severe pneumonia combined with respiratory failure patients.
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