高迁移率族蛋白B1对多药耐药鲍氏不动杆菌医院获得性肺炎患者生存状况的评估价值  

Value of high mobility group protein B1 in assessment of survival status of patients with multidrug resistant Acinetobacter baumannii hospital-acquired pneumonia

作　　者：周明娅 刘菲 任艳 田梅 刘红梅 ZHOU Ming-ya;LIU Fei;REN Yan;TIAN Mei;LIU Hong-mei(Qijiang District Hospital of Traditional Chinese Medicine,Chongqing 401420,China;不详)

机构地区：[1]重庆市綦江区中医院肺病科,重庆401420 [2]重庆市綦江区人民医院医务部,重庆401420

出　　处：《中华医院感染学杂志》2022年第11期1644-1648,共5页Chinese Journal of Nosocomiology

基　　金：重庆市科研基金资助项目(H201931112)。

摘　　要：目的探讨高迁移率族蛋白B1(HMGB1)对多药耐药鲍氏不动杆菌(MDRAB)医院获得性肺炎(HAP)患者生存状况评价的临床意义。方法选取2016年1月-2020年1月于重庆市綦江区中医院确诊的MDRAB HAP患者321例,根据其入院时肺炎严重指数(PSI)分为低危组(n=90)、中危组(n=109)和高危组(n=122),分析三组患者血清HMGB1、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平的差异及其与PSI、预后的关系,绘制受试者工作特征(ROC)曲线评估各指标对MDRAB HAP患者预后的预测效能。结果MDRAB HAP患者肺炎严重程度越高,其血清HMGB1、PCT、TNF-α水平越高(P<0.05);Spearman分析显示,MDRAB HAP患者肺炎严重程度PSI评分与血清HMGB1、PCT、TNF-α水平均呈正相关(P<0.01);临床随访28 d,死亡90例,存活231例,死亡组血清HMGB1、PCT、TNF-α水平均高于存活组(P<0.05);ROC曲线显示,以87.26μg/L为截断点,血清HMGB1预测MDRAB HAP患者死亡的敏感性为83.33%,特异性为73.16%,曲线下面积为0.845,优于PCT和TNF-α。结论HMGB1、PCT及TNF-α在MDRAB HAP患者外周血呈高表达状态,其表达与患者肺炎病情程度呈正相关;检测MDRAB HAP患者血清HMGB1、PCT及TNF-α水平可有效评估疾病进展和患者生存状况。OBJECTIVE To investigate the clinical significance of high mobility group box 1(HMGB1)in evaluating the survival status of patients with hospital-acquired pneumonia(HAP)caused by multi-drug resistant Acinetobacter baumannii(MDRAB).METHODS A total of 321 patients with HAP caused by MDRAB were admitted to the hospital between Jan.2016 and Jan.2020.According to the pneumonia severity index(PSI)at admission,the patients were divided into the low-risk group(n=90,PSI≤90),the intermediate-risk group(n=109,91≤PSI≤130)and the high-risk group(n=122,PSI>130).Serum HMGB1,procalcitonin(PCT)and tumor necrosis factor(TNF-α)levels among the three groups were compared.The relationship of the three indicators with PSI and prognosis was analyzed.The receiver operating characteristic(ROC)curve was plotted to evaluate the prognostic value of each index.RESULTS The severer condition the MDRAB HAP patients got,the higher serum HMGB1,PCT,and TNF-αlevels(P<0.05)were up-regulated.Spearman correlation analysis showed that the PSI score in patients with MDRAB induced HAP was positively correlated with serum HMGB1,PCT and TNF-αlevels(P<0.01).After 28 days of clinical follow-up,90 cases died and 231 cases survived.Serum HMGB1,PCT and TNF-αlevels in the death group were significantly higher than those in the survival group(P<0.05).ROC curve analysis showed that 87.26μg/L was the cut-off value,with the sensitivity of 83.33%and the specificity of 73.16%,and the area under the curve was 0.845,which were all better than those of PCT and TNF-α.CONCLUSION HMGB1,PCT and TNF-αare highly expressed in peripheral blood of patients with MDRAB induced HAP,and the expression of the three proteins is positively correlated with the severity of pneumonia.Detection of serum HMGB1,PCT and TNF-αlevels in patients with MDRAB induced HAP can effectively assess disease progression and patient survival.

关 键 词：鲍氏不动杆菌 多药耐药 泛耐药 医院获得性肺炎 头孢哌酮舒巴坦钠 美罗培南 高迁移率族蛋白B1 生存状况 

分 类 号：R563.1[医药卫生—呼吸系统]