重症肺部感染患者血清感染学指标和免疫学指标对预后的预测价值  

Values of serum infectious and immunological indexes in prediction of prognosis of patients with severe pulmonary infection

作　　者：白植琴[1] 钱彩华[1] 陆华东[2] 琚亚亚 沈慧[1] BAI Zhi-qin;QIAN Cai-hua;LU Hua-dong;JU Ya-ya;SHEN Hui(Huzhou Central Hospital(Central Hospital Affiliatedto Huzhou NormalUniversity),Huzhou,Zhejiang 313000,China)

机构地区：[1]湖州市中心医院(湖州师范学院附属中心医院)呼吸与危重症医学科,浙江湖州313000 [2]湖州市中心医院(湖州师范学院附属中心医院)院感科,浙江湖州313000

出　　处：《中华医院感染学杂志》2022年第20期3052-3056,共5页Chinese Journal of Nosocomiology

基　　金：浙江省科技计划基金资助项目(2017C37155)。

摘　　要：目的探讨重症肺部感染患者血清感染学指标和免疫学指标对临床结局的预测价值。方法回顾性选取2018年1月-2020年1月于湖州市中心医院住院治疗的120例重症肺部感染患者作为研究对象,依据患者治疗1周后的临床结局将其划分为生存组(n=92)和死亡组(n=28),检测两组血清超敏C-反应蛋白(hs-CRP)、可溶性人髓系细胞触发受体-1(sTREM-1)、高迁移率族蛋白B1(HMGB1)及CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)和CD4^(+)/CD_(8)^(+)水平,归纳重症肺部感染患者死亡的影响因素以及采用受试者工作特征(ROC)曲线分析重症肺部感染患者各指标与临床结局的关系。结果死亡组患者的血清hs-CRP、sTREM-1和HMGB1水平均高于生存组(P<0.05),而CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)水平均低于生存组(P<0.05)。hs-CRP、sTREM-1、HMGB1、CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)单独预测重症肺部感染患者死亡的曲线下面积(AUC)均低于六项指标联合预测的AUC值(P<0.05)。多因素分析结果显示,肺炎严重程度(PSI)评分、急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分是重症肺部感染患者死亡的影响因素(P<0.05)。结论血清hs-CRP、sTREM-1、HMGB1、CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)指标与重症肺部感染患者临床结局密切相关,联合检测以上各项指标水平对于临床上预测重症肺部感染患者临床结局具有较高的应用价值。OBJECTIVE To investigate the predictive value of serum infectious and immunological indexes on clinical outcomes in patients with severe lung infection.METHODS A total of 120 patients with severe pulmonary infection who were hospitalized in Huzhou Central Hospital from Jan.2018 to Jan.2020 were retrospectively selected as the research subjects,and they were divided into survival group(n=92)and death group(n=28)according to their clinical outcomes after 1 week of treatment.The levels of serum high-sensitive C-reactive protein(hs-CRP),soluble triggering receptor expressed on myelocytes-1(sTREM-1),high mobility group box 1(HMGB1),CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in both two groups were detected.The influencing factors of death in patients with severe pulmonary infection were summarized,and the receiver operating characteristic(ROC)curves were used to analyze the relationship between each index and clinical outcome in patients with severe pulmonary infection.RESULTS The levels of serum hs-CRP,sTREM-1 and HMGB1 in the death group were higher than those in the survival group(P<0.05),while the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were lower than those in survival group(P<0.05).The area under the curve(AUC)of hs-CRP,sTREM-1,HMGB1,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)alone for predicting death in patients with severe pulmonary infection was lower than the AUC value predicted by the six indicators combined(P<0.05).The results of multivariate analysis showed that pneumonia severity index(PSI)and acute physiology and chronichealth evaluation scoring system(APACHEⅡ)scores were the influencing factors of death in patients with severe pulmonary infection(P<0.05).CONCLUSION The serum hs-CRP,sTREM-1,HMGB1,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were closely related to the clinical outcomes in patients with severe pulmonary infection.The combined detection of the above indexes was of high predictive value for clinical outcomes of patients with severe pulmonary infection.

关 键 词：重症肺部感染 免疫学指标 炎性细胞因子 临床结局 预测价值 死亡 影响因素 

分 类 号：R563.1[医药卫生—呼吸系统]