血浆血管生成素-2、白细胞介素-8在重症社区获得性肺炎疾病严重程度及其预后评估中的价值  

Value of plasma Ang-2 and IL-8 in severity and prognosis of severe community acquired pneumonia

作　　者：陈婷[1] 周小妹[1] 姚莉[1] 朱春艳[2] CHEN Ting;ZHOU Xiaomei;YAO Li;ZHU Chunyan(Department of Intensive Care Unit,The Second People’s Hospital of Hefei,Hefei,Anhui 230011,China;Department of Intensive Care Unit,Anhui Provincial Hospital,Hefei,Anhui 230032,China)

机构地区：[1]合肥市第二人民医院重症医学科,安徽合肥230011 [2]安徽省立医院重症医学科,安徽合肥230032

出　　处：《安徽医药》2020年第3期488-491,I0005,共5页Anhui Medical and Pharmaceutical Journal

基　　金：安徽省公益性技术应用研究联动计划项目(15011d04060)

摘　　要：目的探讨血浆内血管生成素⁃2(Ang⁃2)、白细胞介素⁃8(IL⁃8)与重症社区获得性肺炎(SCAP)病人疾病严重程度及其预后的价值。方法收集2016年1月1日至2018年8月31日合肥市第二人民医院重症医学科(ICU)收治的SCAP病人68例,分别检测病人的C反应蛋白(CRP)、IL⁃8、血浆Ang⁃2水平,进行急性生理与慢性健康评分(APACHEⅡ)和氧合指数(PO2/FiO2)记录,根据28 d转归结果将其中纳入标准的65例SCAP病人(另外3例近亲属中途放弃治疗而退出)分为存活组(35人)及死亡组(30人)。结果死亡组病人CRP[(147.99±55.94)mg/L比(108.59±48.19)mg/L,t=3.051,P=0.003]、APACHEⅡ评分[(25.47±5.43)分比(18.23±5.78)分,t=5.176,P=0.000]、氧合指数[(158.67±92.36)比(269.20±122.24),t=4.056,P=0.000]、血浆Ang⁃2[(1.89±0.68)mg/mL比(1.40±0.81)mg/mL,t=2.636,P=0.011],IL⁃8[(365.18±219.08)pg/mL比(228.35±181.24)pg/mL,t=2.756,P=0.008]均明显高于存活组。Ang⁃2同APACHEⅡ评分(r=0.847,P=0.001)、IL⁃8(r=0.967,P=0.013)、CRP(r=0.853,P=0.018)呈正相关,同氧合指数呈负相关(r=-0.429,P=0.003);logistic回归分析显示,IL⁃8、Ang⁃2是SCAP死亡危险因素(OR=1.004和OR=1.001,P<0.05);血清Ang⁃2和IL⁃8评分水平判断病人预后的受试者工作特征曲线(ROC)下面积分别是0.761和0.671,其中Ang⁃2阈值是790.50 ng/mL时,灵敏度95.6%,特异度87.1%;IL⁃8阈值是75.62 pg/mL时,灵敏度82.3%,特异度67.1%。结论血浆IL⁃8、Ang⁃2是可作为SCAP病人疾病严重程度评价指标,同时Ang⁃2可能为SCAP潜在预后指标。Objective To explore the value of plasma Angiopoietin⁃2(Ang⁃2)and IL⁃8 in the severity and prognosis of severe community⁃acquired pneumonia(SCAP).Methods 68 patients with SCAP in The Second People’s Hospital of Hefei admitted to Intensive Care Unit(ICU)from January 1st,2016 to August 31st,2018 were collected.The levels of C⁃reactive protein(CRP),interleukin⁃8(IL⁃8)and plasma Ang⁃2 were measured.The acute physiology and chronic health score(APACHEⅡ)and oxygenation index(PO2/FiO2)were recorded.According to the outcome of 28 days,65 SCAP patients(3 patients quit during the treatmnet)were divided into survival group(35)and non⁃survival group(30).Results C⁃reactive protein(CRP)[(147.99±55.94)mg/L vs.(108.59±48.19)mg/L,t=3.051,P=0.003],APACHE Ⅱ score[(25.47±5.43)vs.(18.23±5.78),t=5.176,P=0.000],oxygenation index(PO2/FiO2)[(158.67±92.36)vs.(269.20±122.24),t=4.056,P=0.000],plasma Ang⁃2[(1.89±0.68)mg/mL vs.(1.40±0.81)mg/mL,t=2.636,P=0.011]and IL⁃8[(365.18±219.08)pg/mL vs.(228.35±181.24)pg/mL,t=2.756,P=0.008]in the death group were significantly higher than those in the survival group(P<0.05).Ang⁃2 was positively correlated with APACHEⅡscore(r=0.847,P=0.001),IL⁃8(r=0.967,P=0.013)and CRP(r=0.853,P=0.018),negatively correlated with oxygenation index(r=-0.429,P=0.003).Logistic regression analysis showed that IL⁃8 and Ang⁃2 were risk factors for SCAP mortality(OR=1.004 and OR=1.001,P<0.05).The areas under ROC curve of serum Ang⁃2 and IL⁃8 were 0.761 and 0.671 respectively.When Ang⁃2 threshold was 790.50 ng/mL,sensitivity and specificity is 95.6%and 87.1%respectively.When IL⁃8 threshold was 75.62 pg/mL,sensitivity and specificity is 82.3%and 67.1%respectively.Conclusion Plasma IL⁃8 and Ang⁃2 can be used as indicators of disease severity in SCAP patients,also may be potential prognostic indicators of SCAP.

关 键 词：社区获得性感染/诊断 肺炎 C反应蛋白质 血管生成素⁃2 白细胞介素8 评估 

分 类 号：R563.1[医药卫生—呼吸系统]