老年重症社区获得性肺炎患者血清HMGB-1对短期不良预后的预测效能  

Prediction value of serum HMGB-1 in elderly patients with severe community-acquired pneumonia for short-term adverse outcomes

作　　者：孙纯[1] 刘芳[1] 龙媛熙 Sun Chun;Liu Fang;Long Yuanxi(Department of Intensive Care Unit,Wuhan First Hospital,Wuhan Hubei 430022,China)

机构地区：[1]武汉市第一医院重症监护室,湖北武汉430022

出　　处：《遵义医科大学学报》2022年第2期194-199,共6页Journal of Zunyi Medical University

基　　金：武汉市科学技术局基金资助项目(NO:WZ10C04)。

摘　　要：目的分析血清高迁移率族蛋白-1(HMGB-1)在重症社区获得性肺炎(sCAP)预后预测中的作用。方法选取2017年1月至2020年12月期间在我院住院的老年sCAP患者114例为sCAP组,同时选取114例健康者为健康对照组。比较两组受试者血清HMGB-1及炎症因子水平。分析sCAP组患者血清基线HMGB-1水平与患者临床特征的关系。采用COX比例风险回归模型分析影响sCAP患者30 d死亡风险的临床因素。应用受试者工作特征(ROC)曲线分析血清HMGB-1水平、PSI、CURB-65预测sCAP患者30 d死亡风险。结果与对照组相比,sCAP组患者血清HMGB-1、TNF-α、IL-6、IL-1β、CRP基线水平显著升高(P<0.05)。高HMGB-1亚组患者PSI、CURB-65评分以及1个月死亡率较高(P<0.05)。血清HMGB-1基线水平与基线PSI、CURB-65评分、呼吸频率呈正相关性(r=0.349,0.240,0.427,P<0.05)。经单因素COX风险比例模型分析,呼吸频率、PSI、CURB-65评分、血清HMGB-1水平与sCAP患者30 d内死亡有关(P<0.05);多变量分析中PSI、CURB-65评分和血清HMGB-1水平是影响sCAP患者30 d内死亡风险的独立危险因素(P<0.05)。PSI>115亚组、PSI≤115亚组或CURB-65评分>3.5分亚组患者,HMGB-1>2048.14 pg/mL亚组患者的死亡风险明显更高(P<0.05);CURB-65评分≤3.5分亚组患者,HMGB-1>2048.14 pg/mL亚组和≤2048.14 pg/mL亚组患者的死亡风险无明显差异(P>0.05)。经ROC曲线分析,血清HMGB-1联合PSI或CURB-65评分预测sCAP患者30 d内死亡风险的AUC(95%CI)均大于PSI、CURB-65评分单独预测的AUC值(Z=-4.155,-3.7159,P<0.05)。结论血清HMGB-1联合PSI或CURB-65评分系统可以增加老年sCAP患者短期不良预后的预测效能。Objective To investigate the prognostic value of serum high mobility group protein-1(HMGB-1)in severe community-acquired pneumonia(sCAP).Methods A total of 114 elderly sCAP patients hospitalized in our hospital from January 2017 to December 2020 were enrolled as the sCAP group,while 114 healthy subjects were enrolled as the healthy control group to analyse the serum levels of hMGB-1 and inflammatory factors.The relationship between baseline serum HMGB-1 level and clinical characteristics of patients in sCAP group was analyzed.COX proportional risk regression model was used to analyze the clinical factors influencing the 30-day death risk of sCAP patients.Receiver operating characteristic(ROC)curve was used to analyze serum HMGB-1 level,PSI and curB-65 to predict 30 d death risk of sCAP patients.Results Compared with the control group,the baseline levels of serum HMGB-1,TNF-α,IL-6,IL-1βand CRP in sCAP group were significantly increased(P<0.05).PSI,curB-65 scores and 1-month mortality were higher in patients with high HMGB-1 subgroup(P<0.05).Baseline serum HMGB-1 level was positively correlated with baseline PSI,curB-65 score and respiratory rate(r=0.349,0.240,0.427,P<0.05).According to univariate COX proportional hazard model,respiratory rate,PSI,curB-65 score and serum HMGB-1 level were positively associated with death within 30 days of sCAP patients(P<0.05).In multivariate analysis,PSI,CURB-65 score and serum HMGB-1 level were independent risk factors for death within 30 days in patients with sCAP(P<0.05).Patients with PSI>115 subgroup,PSI≤115 subgroup or CURB-65 score>3.5 subgroup had a significantly higher risk of death(P<0.05).There was no significant difference in the risk of death between patients with CURB-65≤3.5 score and those with HMGB-1>2048.14 pg/ml(P>0.05).ROC curve analysis showed that the AUC(95%CI)of serum HMGB-1 combined with PSI or CURB-65 was greater than that of PSI and curB-65 alone(Z=-4.155,-3.7159,P<0.05).Conclusion Serum HMGB-1 in combination with PSI or curB-65 scoring system increa

关 键 词：重症社区获得性肺炎 高迁移率族蛋白-1 肺炎严重指数 预后 

分 类 号：R563.1[医药卫生—呼吸系统]