摘要
目的:探讨肝素结合蛋白(heparin binding protein,HBP)、IL-10、TNF-α、CRP 与重症肺炎(severe pneumonia,SP)合并呼吸衰竭(respiratory failure,RF)患者病情严重程度及预后的关系研究.方法:选取2020年1月至2023年6月张家口市第一医院收治的肺炎患者89例纳入A组,SP患者81例纳入B组,SP合并RF患者76例纳入C组,根据SP合并RF患者入院28d后是否存活,将患者分为死亡组(25例)和存活组(51例).比较三组血清HBP、IL-10、TNF-α、CRP水平、病情严重程度指标,通过Person相关性分析法分析血清HBP、IL-10、TNF-α、CRP水平与病情严重程度指标的相关性,绘制受试者工作特征(ROC)曲线分析各项指标单独及联合的预测价值.结果:A组、B 组、C 组血清 HBP、TNF-α、CRP、IL-10 水平、序贯器官衰竭(sequential organ failure,SOFA)评分、急性生理和慢性健康(score of acute physiology and chronic health,APACHE Ⅱ)评分呈升高趋势(P＜0.05).Person相关性分析法结果显示,血清HBP、IL-10、TNF-α、CRP水平与SOFA、APACHE Ⅱ呈正相关(r=0.580、0.422,0.455、0.394,0.399、0.373,0.337、0.537,P＜0.05).存活组血清 HBP、TNF-α、CRP水平低于死亡组,IL-10水平高于死亡组(P＜0.05).将死亡纳入阳性,存活纳入阴性,绘制ROC曲线分析清HBP、IL-10、TNF-α、CRP单独及联合对SP合并RF患者预后的预测价值,敏感性 68.00％、84.00％、72.00％、80.00％、88.00％,特异性为 70.59％、64.71％、66.67％、60.78％、92.16％,曲线下面积(AUC)为0.718、0.736、0.742、0.772、0.921,联合检测均为最高.结论:SP合并RF患者HBP、TNF-α、CRP、IL-10水平升高,且与病情严重程度密切相关,联合检测对SP合并RF患者预后具有较高的预测价值.
Abstract
Objective:To investigate the relationship between heparin binding protein(HBP),IL-10,TNF-α,CRP and the severity and prognosis of severe pneumonia(SP)complicated with respiratory failure(RF).Methods:Eighty-nine patients with pneumonia admitted to The First Hospital of Zhangjiakou City from January 2020 to June 2023 were included in the group A,SP were included in the group B(81 cases),and SP combined with RF were included in the group C(76 cases).According to whether the patients with SP combined with RF survived 28 d after admission,the patients were divided into the death group(25 cases)and the survival group(51 cases).Serum levels of HBP,IL-10,TNF-α,CRP and the severity of the disease were compared among the three the groups,and the correlation between serum levels of HBP,IL-10,TNF-α and CRP and the severity of the disease was analyzed by Person correlation analysis.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of individual and combined measurements.Results:The levels of serum HBP,TNF-α,CRP,IL-10,score of sequential organ failure(SOFA),score of acute physiology and chronic health(APACHEⅡ)in the groups A,B and Cincreased(P＜0.05).The results of Person correlation analysis showed that the serum levels of HBP,IL-10,TNF-α and CRP were positively correlated with SOFA and APACHEII(r=0.580,0.422,0.455,0.394,0.399,0.373,0.337,0.537,P＜0.05).The levels of serum HBP,TNF-α and CRP in survival the group were lower than those in death the group,and the levels of IL-10 were higher than those in death the group(P＜0.05).Death was included as positive and survival as negative.ROC curve was drawn to analyze the prognostic value of clear HBP,IL-10,TNF-α and CRP alone and in combination in SP patients with RF.The area under the curve(AUC)was 0.718,0.736,0.742,0.772,0.921.The sensitivity was 68.00％,84.00％,72.00％,80.00％,88.00％,and the specificity was 70.59％,64.71％,66.67％,60.78％,92.16％,which were the highest in combined detection.Conclusion:The levels of HBP,TNF-α,CRP and IL-10 increased in patients with SP combined with RF,which was closely related to the severity of the disease,combined detection had high prognotic value in patients with SP combined with RF.
基金项目
河北省卫生健康委员会2022年计划项目(20221895)
维普
万方数据