血清sTREM-1、PCT水平及APACHEⅡ、MODS评分与老年重症肺炎伴呼吸衰竭患者预后的相关性分析

doi:10.3969/j.issn.1671-7171.2022.06.021

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摘要【目的】探讨血清可溶性髓样细胞触发受体(sTREM-1)、降钙素原(PCT)及急性生理与慢性健康评分 Ⅱ(APACHE Ⅱ)、多器官功能障碍评分(MODS)与老年重症肺炎(SP)伴呼吸衰竭(RF)患者预后的相关性。【方法】回顾性分析2019年4月至2021年4月在本院诊治的164例SP伴RF患者的临床资料,患者入院后均接受抗感染、化痰、纠正水电解质等常规治疗。依据患者治疗效果分为预后良好组(显效+有效,n=92)与预后不良组(n=72)。比较两组基础资料信息[性别、年龄、体重指数(BMI)、居住地区、吸烟史、饮酒史、免疫抑制剂或糖皮质激素使用史、合并疾病(高血压、糖尿病、慢性阻塞性肺疾病、高脂血症)、是否机械通气、RF分类、APACHE Ⅱ评分、MODS评分]及实验室指标(sTREM-1、PCT)差异,通过受试者工作特征(ROC)曲线分析年龄、APACHE Ⅱ评分、MODS评分及sTREM-1、PCT水平对SP伴RF患者预后的预测价值,采用多因素Logistic回归分析SP伴RF患者预后不良的危险因素。【结果】164例患者中预后良好56.10%(92/164),预后不良43.90%(72/164)。两组性别、BMI、居住地区、饮酒史、免疫抑制剂或糖皮质激素使用史、合并高血压、合并慢性阻塞性肺疾病、合并高脂血症、RF分类比较,差异无统计学意义(P>0.05);预后不良组有吸烟史、合并糖尿病、机械通气患者占比显著高于预后良好组(P<0.05),年龄、APACHE Ⅱ评分、MODS评分及血清sTREM-1、PCT水平也显著高于预后良好组(P<0.05)。ROC曲线分析结果显示:年龄、APACHE Ⅱ评分、MODS评分、sTREM-1、PCT均可预测SP伴RF患者预后。多因素Logistic回归分析结果显示:有吸烟史、合并糖尿病、机械通气、年龄≥76岁、APACHE Ⅱ评分≥17.880分、MODS评分≥9.835分、sTREM-1≥81.375 ng/L、PCT≥22.220 μg/L是SP伴RF患者预后不良的危险因素。【结论】血清sTREM-1、PCT及APACHE Ⅱ、MODS评分可影响SP伴RF患者预后,当APACHE Ⅱ评分≥17.880分、MODS评分≥9.835分、sTREM-1≥81.375 ng/L、PCT≥22.220 μg/L时可预测此类患者的预后。

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关键词 ：肺炎/并发症, 呼吸功能不全/并发症, 降钙素/分析, 膜糖蛋白类/血液, 老年人, 预后

Abstract：【Objective】 To investigate the correlation between serum soluble myeloid cell trigger receptor (sTREM-1),procalcitonin (PCT),acute physiology and chronic health score Ⅱ (APACHEⅡ),multiple organ dysfunction score (MODS) and the prognosis of elderly patients with severe pneumonia (SP) and respiratory failure (RF).【Methods】 The clinical data of 164 patients with SP and RF diagnosed and treated in our hospital from April 2019 to April 2021 were retrospectively analyzed. After admission,all patients received routine treatment such as anti infection,expectoration,correction of water and electrolyte. According to the treatment effect,the patients were divided into good prognosis group (significantly effective + effective,n=92) and poor prognosis group (n=72). The basic data of the two groups were compared [gender,age,body mass index (BMI),residential area,smoking history,drinking history,history of immunosuppressant or glucocorticoid use,combined diseases (hypertension,diabetes,chronic obstructive pulmonary disease,hyperlipidemia),mechanical ventilation,RF classification,acute physiology and APACHE Ⅱ score,MODS score] and laboratory indicators (sTREM-1,PCT) difference. The predictive value of age,APACHE Ⅱ score,MODS score,sTREM-1 and PCT level on the prognosis of patients with SP and RF was analyzed by receiver operating characteristic (ROC) curve. The risk factors for poor prognosis of patients with SP and RF were analyzed by multivariate logistic regression.【Results】 Among the 164 patients,56.10% (92/164) had a good prognosis and 43.90% (72/164) had a poor prognosis. There was no significant difference between the two groups in terms of gender,BMI,residential area,drinking history,history of immunosuppressant or glucocorticoid use,hypertension,chronic obstructive pulmonary disease,hyperlipidemia and RF classification (P>0.05); The proportion of patients with smoking history,diabetes and mechanical ventilation in the poor prognosis group was significantly higher than that in the good prognosis group(P>0.05). ROC curve analysis showed that age,APACHE Ⅱ score,MODS score,sTREM-1 and PCT could predict the prognosis of patients with SP and RF. The results of multivariate logistic regression analysis showed that:smoking history,diabetes,mechanical ventilation,age ≥ 76 years,Apache Ⅱ score ≥ 17.880,MODS score ≥ 9.835,sTREM-1 ≥ 81.375 ng/L,PCT ≥ 22.220 μg/L were risk factors for poor prognosis in patients with SP and RF.【Conclusion】Serum sTREM-1,PCT,APACHE Ⅱ and MODS scores can affect the prognosis of patients with SP and RF. When APACHE Ⅱ score≥17.880,MODS score≥9.835,sTREM-1≥81.375 ng/L,PCT≥22.220 μg/L can predict the prognosis of such patients.

Key words： Pneumonia/CO Respiratory Insufficiency/CO Calcitonin/AN Membrane Glycoproteins/AN Aged Prognosis

收稿日期: 2022-01-14

中图分类号:

R563.1

通讯作者: *E-mail:yucongyi19810120@163.com

引用本文:

俞淙轶, 龙贻文. 血清sTREM-1、PCT水平及APACHEⅡ、MODS评分与老年重症肺炎伴呼吸衰竭患者预后的相关性分析[J]. 医学临床研究, 2022, 39(6): 877-880.
YU Cong-yi, LONG Yi-wen. Correlation between Serum Levels of sTREM-1,PCT,APACHE Ⅱ,MODS and Prognosis of Elderly Patients with Severe Pneumonia and Respiratory Failure. JOURNAL OF CLINICAL RESEARCH, 2022, 39(6): 877-880.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.06.021 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I6/877

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