IL-17、PCT/ALB、mHLA-DR对老年ICU COPD多重耐药鲍曼不动杆菌血流感染患者病情评估的价值及对预后的影响  

Values of IL-17,PCT/ALB and mHLA-DR in Evaluation of Conditions of COPD Patients with Multidrug Resistant Acinetobacter Baumannii Bloodstream Infection in Geriatric ICU and Their Effects on Prognoses

作　　者：苏晓蕾[1] 赵睿[1] 房开宇[1] SU Xiao-lei;ZHAO Rui;FANG Kai-yu(Department of Critical Medicine,the Central Hospital of Dalian City,Dalian,Liaoning 116033,China)

机构地区：[1]大连市中心医院重症医学科,大连116033

出　　处：《解放军医药杂志》2021年第11期72-75,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：辽宁省自然科学基金计划指导项目(2019-ZD-0302)。

摘　　要：目的探讨白细胞介素-17(IL-17)、降钙素原与白蛋白比值(PCT/ALB)、单核细胞人白细胞抗原-DR(mHLA-DR)在老年重症监护病房(ICU)慢性阻塞性肺疾病(COPD)多重耐药鲍曼不动杆菌血流感染患者病情评估中的价值及对预后的影响。方法选取2018年9月—2020年10月我院收治的80例老年ICU COPD多重耐药鲍曼不动杆菌血流感染患者,根据28 d预后分为死亡组21例和生存组59例,比较2组治疗前及治疗3、7 d后IL-17、PCT/ALB、mHLA-DR、急性生理学与慢性健康状况评分系统(APACHE)Ⅱ评分,采用Pearson相关性分析探讨IL-17、PCT/ALB、mHLA-DR与APACHEⅡ评分的关系,采用Cox回归分析探讨预后影响因素,采用受试者工作特征(ROC)曲线分析上述指标评估预后的效能。结果与生存组比较,死亡组治疗3、7 d后IL-17、PCT/ALB升高,mHLA-DR降低,APACHEⅡ评分升高(P<0.05,P<0.01)。Pearson相关性分析显示,治疗3、7 d后IL-17、PCT/ALB与APACHEⅡ评分呈正相关(P<0.01),mHLA-DR与APACHEⅡ评分呈负相关(P<0.01)。Cox回归分析显示,治疗3、7 d后IL-17、PCT/ALB、mHLA-DR是老年ICU COPD多重耐药鲍曼不动杆菌血流感染患者预后的影响因素(P<0.01)。ROC曲线分析显示,治疗7 d后IL-17、PCT/ALB、mHLA-DR评估预后的曲线下面积最大,联合评估预后的效能优于任一单一指标评估。结论IL-17、PCT/ALB、mHLA-DR与老年ICU COPD多重耐药鲍曼不动杆菌血流感染患者病情程度和预后有关,在缺乏有效预测手段时,可作为评估预后的生物学标志物,为临床干预提供参考信息。Objective To investigate values of interleukin-17(IL-17),procalcitonin to albumin ratio(PCT/ALB)and monocyte human leukocyte antigen DR(mHLA-DR)in evaluation of Chronic obstructive pulmonary disease(COPD)patients with multidrug-resistant Acinetobacter baumannii bloodstream infection in geriatric intensive care unit(ICU)and their effects on prognoses.Methods Eighty COPD patients with multidrug-resistant Acinetobacter baumannii bloodstream infection in geriatric ICU treated between September 2018 and October 2020 were divided into death group(n=21)and survival group(n=59)according to the 28-d prognosis.Levels of IL-17,PCT/ALB,mHLA-DR,and scores of acute physiology and chronic health evaluation(APACHE)Ⅱbefore and after treatment for 3 and 7 d were compared between two groups.Pearson correlation analysis was used to explore correlations between IL-17,PCT/ALB,mHLA-DR with APACHEⅡscore.Cox regression analysis was used to explore influencing factors of prognoses,and receiver operating characteristic(ROC)curve was used to analyze the efficiencies of the above indexes to evaluate the prognoses.Results Compared with those in survival group,levels of IL-17 and PCT/ALB were significantly increased,while mHLA-DR level was significantly decreased,and APACHEⅡscore was significantly increased in death group after treatment for 3 and 7 d(P<0.05,P<0.01).Pearson correlation analysis showed that IL-17 and PCT/ALB were positively correlated with APACHEⅡscore(P<0.01),while mHLA-DR was negatively correlated with APACHEⅡscore after treatment for 3 and 7 d(P<0.01).Cox regression analysis showed that IL-17,PCT/ALB and mHLA-DR were influencing factors of prognoses in elderly COPD patients with multidrug resistant Acinetobacter baumannii bloodstream infection after treatment for 3 and 7 d in geriatric ICU(P<0.01).ROC curve analysis showed that the area under the curve of combined detection of IL-17,PCT/ALB and mHLA-DR was the largest after treatment for 7 d,and the efficiency of combined evaluation for the prognosis was superior t

关 键 词：肺疾病 慢性阻塞性 鲍曼不动杆菌感染 老年人 白细胞介素-17 影响因素分析 预后 

分 类 号：R446.5[医药卫生—诊断学] R563.9[医药卫生—临床医学]