口腔颌面外科术后呼吸机相关性肺炎患者血清铁调素和铁蛋白临床分析  

Clinical study of serum hepcidin and ferritin for ventilator-associated pneumonia after oral and maxillofacial surgery

作　　者：王烨 胡蓉[1] 王圆[1] 黄燕[1] WANG Ye;HU Rong;WANG Yuan;HUANG yan(Department of Anesthesiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine.Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海200011

出　　处：《中国口腔颌面外科杂志》2021年第3期234-237,共4页China Journal of Oral and Maxillofacial Surgery

基　　金：上海交通大学医学院附属第九人民医院临床研究助力计划(JYLJ201820)。

摘　　要：目的:研究口腔颌面外科术后呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者血清铁调素和铁蛋白的含量及临床意义。方法:选择2017年1月—2019年12月上海交通大学医学院附属第九人民医院收治的口腔颌面外科手术后行呼吸机治疗的患者196例,依据是否发生呼吸机相关肺炎分为VAP组(n=100)和非VAP组(n=96)。根据急性生理与慢性健康Ⅱ(APACHEⅡ)评分,将VAP患者分为低危、中危和高危组。检测所有入组患者血清PCT、铁调素和铁蛋白水平。采用SPSS 23.0软件包进行统计学分析,t检验或χ2检验比较2组患者的临床和血清学指标,Spearman相关分析评价上述指标与VAP患者疾病严重程度的关系。结果:VAP组患者住院时间和机械通气时间均显著高于非VAP组(P<0.05);VAP组患者PCT水平及APACHEⅡ评分分别为(2.13±0.95)ng/mL、(23.68±6.70)分,显著高于非VAP组的(0.87±0.46)ng/mL、(17.22±5.19)分(P<0.05)。VAP组患者血清铁蛋白、铁调素和铁蛋白/铁调素比值分别为(217.79±62.38)ng/mL、(57.62±9.60)ng/mL和3.79±0.93,显著高于非VAP组患者的(181.55±54.02)ng/mL,(50.58±8.52)ng/mL和3.11±0.86(P<0.05)。低危组、中危组和高危组VAP患者血清铁蛋白、铁调素水平和铁蛋白/铁调素比值逐渐升高,差异有统计学意义(P均<0.05)。VAP病情严重程度与血清PCT、铁调素、铁蛋白及铁蛋白/铁调素比值呈正相关(r值分别为0.772、0.811、0.873、0.898,P均<0.05)。结论:血清铁调素、铁蛋白及铁蛋白/铁调素在口腔颌面外科术后VAP患者中显著升高,可用于评估口腔颌面外科VAP患者病情严重程度。PURPOSE: To investigate the changes and clinical significance of serum hepcidin and ferritin in patients with ventilator-associated pneumonia(VAP) after oral and maxillofacial surgery. METHODS: One hundred and ninety-six patients who underwent ventilator treatment after oral and maxillofacial surgery from January 2017 to December 2019 in Shanghai Ninth People’s Hospital were selected. The patients were categorized into VAP group(n =100) and non-VAP group(n =96). VAP patients were divided into low-risk, intermediate-risk and high-risk subgroup, according to Acute Physiology and Chronic HealthⅡ(APACHEⅡ) score. The level of serum procalcitonin(PCT), hepcidin and ferritin was detected. SPSS 23.0 software package was used for statistical analysis. RESULTS: The hospitalization time and mechanical ventilation time of VAP group were significantly higher than those of non-VAP group(P<0.05). The PCT level and APACHEⅡ score of VAP group were(2.13±0.95)ng/mL and(23.68±6.70) points, which were both significantly higher than those in non-VAP group:(0.87±0.46)ng/mL and(17.22±5.19) points(P<0.05). The serum level of ferritin, hepcidin and ratio of ferritin/hepcidin in VAP group was(217.79±62.38) ng/mL,(57.62±9.60) ng/mL and 3.79±0.93, which was significantly higher than those in non-VAP group:(181.55±54.02) ng/mL,(50.58±8.52) ng/mL and 3.11±0.86, respectively(P<0.05). The serum level of ferritin, hepcidin and ratio of ferritin/hepcidin in VAP patients in the low-risk subgroup, intermediate-risk subgroup and high-risk subgroup gradually increased(P<0.05). Spearman correlation analysis found that the severity of VAP was positively correlated with serum PCT, hepcidin, ferritin, and ferritin/hepcidin ratio(r=0.772, 0.811,0.873, 0.898;P<0.05). CONCLUSIONS: Serum hepcidin and ferritin were significantly elevated in VAP patients, which can be used to evaluate the severity of VAP patients.

关 键 词：重症医学 呼吸机相关性肺炎 铁调素 铁蛋白 

分 类 号：R782.05[医药卫生—口腔医学]