摘要
目的 分析成人重症肺炎患者血清降钙素原、白细胞介素-17(IL-17)、可溶性髓系细胞触发受体-1(sTREM-1)水平的变化及临床意义.方法 回顾性分析2021年12月至2023年9月在沧州市人民医院进行治疗的120例重症肺炎患者的临床资料,将其设为观察组.依据英国胸科协会改良肺炎评分(CURB-65)将其分为1级(n=37)、2级(n=59)、3级(n=24),另选同期体检健康的志愿者100名,设为对照组.记录院内28 d观察组所有患者存活情况,将其分为存活组(n=81)、死亡组(n=39).比较观察组与对照组、不同病情严重程度患者、不同预后患者的血清降钙素原、IL-17、sTREM-1水平,采用ROC曲线分析血清降钙素原、IL-17、sTREM-1水平预测重症肺炎患者预后的价值.结果 观察组血清降钙素原、IL-17、sTREM-1水平分别为(7.35±0.84)ng/mL、(23.97±4.21)pg/mL、(168.46±32.13)pg/mL,均高于对照组[(2.13±0.21)ng/mL、(8.53±2.26)pg/mL、(35.94±9.21)pg/mL],差异均有统计学意义(P＜0.05).1级患者血清降钙素原、IL-17、sTREM-1水平分别为(5.67±0.82)ng/mL、(15.52±3.94)pg/mL、(143.35±26.84)pg/mL,低于 2 级患者[(7.89±0.94)ng/mL、(22.68±4.16)pg/mL、(170.28±28.63)pg/mL],2 级患者降钙素原、IL-17、sTREM-1 水平低于 3 级患者[(8.96±1.13)ng/mL、(29.13±4.69)pg/mL、(191.54±30.67)pg/mL],差异均有统计学意义(P＜0.05).存活组血清降钙素原、IL-17、sTREM-1水平分别为(4.93±0.62)ng/mL、(16.45±3.81)pg/mL、(154.67±29.87)pg/mL,均低于死亡组[(5.84±0.67)ng/mL、(20.37±3.69)pg/mL、(173.64±30.26)pg/mL],差异均有统计学意义(P＜0.05).经ROC曲线分析证实降钙素原、IL-17、sTREM-1水平均可用于预测重症肺炎患者预后,曲线下面积分别为0.842、0.819、0.787.结论 降钙素原、IL-17、sTREM-1水平升高与患者病情严重程度关系密切,另以上指标过表达将影响患者预后,临床诊治时可结合以上指标进一步筛查高危患者,及时给予干预措施,改善患者预后.
Abstract
Objective To explore the changes of serum levels of procalcitonin,interleukin-17(IL-17)and soluble myeloid cell trigger receptor-1(sTREM-1)in adult patients with severe pneumonia and their clinical significance.Methods The clinical data of 120 patients with severe pneumonia treated in Cangzhou Peoples Hospital from December 2021 to September 2023 were retrospectively analyzed.They were set the observation group.They were divided into grade 1(n=37),grade 2(n=59)and grade 3(n=24)according to the CURB-65 modified pneumonia score of the British Thoracic Society,and 100 healthy volunteers were selected during the same period.They were set the control group.The survival status of all patients in the 28 day observation group in the hospital was recorded and divided into a survival group(n=81)and a death group(n=39).The levels of serum procalcitonin,IL-17 and sTREM-1 of the observation group and the control group,patients with different severity of disease and patients with different prognosis were compared,and the value of serum procalcitonin,IL-17 and sTREM-1 lev-els in predicting prognosis of patients with severe pneumonia was analyzed by receiver operating characteristic(ROC)curve.Results The serum levels of procalcitonin,IL-17,and sTREM-1 in the observation group were(7.35±0.84)ng/mL,(23.97±4.21)pg/mL,and(168.46±32.13)pg/mL,respectively,which were higher than those in the control group[(2.13±0.21)ng/mL,(8.53±2.26)pg/mL,and(35.94±9.21)pg/mL],and the differences were statistically significant(P＜0.05).The serum levels of procalcitonin,IL-17,and sTREM-1 in grade 1 patients were(5.67±0.82)ng/mL,(15.52±3.94)pg/mL,and(143.35±26.84)pg/mL,respectively,which were lower than those in grade 2 patients[(7.89±0.94)ng/mL,(22.68±4.16)pg/mL,(170.28±28.63)pg/mL],the levels of procalcitonin,IL-17,and sTREM-1 in grade 2 patients were lower than those in grade 3 patients[(8.96±1.13)ng/mL,(29.13±4.69)pg/mL,(191.54±30.67)pg/mL],the differences were statistically significant(P＜0.05).The serum levels of procalcitonin,IL-17,and sTREM-1 in the survival group were(4.93±0.62)ng/mL,(16.45±3.81)pg/mL,and(154.67±29.87)pg/mL,respectively,lower than those in the death group[(5.84±0.67)ng/mL,(20.37±3.69)pg/mL,and(173.64±30.26)pg/mL],and the differences were statistically significant(P＜0.05).ROC curve analysis confirmed that procalcitonin,IL-17 and sTREM-1 levels could be used to predict the prognosis of patients with severe pneumonia,and the areas under the curve were 0.842,0.819 and 0.787,respectively.Conclusion The elevated levels of procalcitonin,IL-17 and sTREM-1 are closely related to the severity of patients'disease,and the overexpression of the above indicators will affect the prognosis of patients.In clinical diagnosis and treatment,high-risk patients can be further screened with the above indicators,and timely intervention measures can be given to improve the prognosis of patients.
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