老年重症肺炎并呼吸衰竭患者血清可溶性CD40配体和正五聚体蛋白-3水平变化及临床意义  

Changes and clinical significance of serum soluble CD40 ligand and pentraxin-3 levels in elderly patients with severe pneumonia and respiratory failure

作　　者：马群[1] 李卫阳[1] 许蒙[1] MA Qun;LI Weiyang;XU Meng(Second Department of Respiratory and Critical Care Medicine,Nanyang First People's Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳市第一人民医院呼吸与危重症医学二科,河南南阳473000

出　　处：《新乡医学院学报》2023年第7期659-663,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨老年重症肺炎并呼吸衰竭患者血清可溶性CD40配体(CD40L)、正五聚体蛋白-3(PTX3)水平变化及临床意义。方法选择2020年1月至2022年1月南阳市第一人民医院收治的98例老年重症肺炎并呼吸衰竭患者为研究对象。收集患者的年龄、性别、是否吸烟、基础疾病(糖尿病、冠状动脉性心脏病、高血压、慢性阻塞性肺疾病)、是否行机械通气以及血白细胞计数、血清白蛋白和血红蛋白水平等一般临床资料。采集患者入院后24 h内的空腹外周静脉血,采用酶联免疫吸附法检测血清CD40L、PTX3水平。入院后24 h内行急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分,根据APACHEⅡ评分将患者分为低危组(<10分,n=25)、中危组(10~20分,n=40)、高危组(>20分,n=33),比较3组患者的血清CD40L、PTX3水平;根据患者入院后30 d内是否死亡,将患者分为死亡组(n=69)和存活组(n=29),比较2组患者的血清CD40L、PTX3水平、APACHEⅡ评分及其他临床资料;采用logistic回归分析患者预后影响因素,受试者操作特征(ROC)曲线分析血清CD40L、PTX3水平对患者预后的预测价值。结果低危组、中危组和高危组患者血清CD40L、PTX3水平比较差异有统计学意义(F=28.690、199.407,P<0.05);中危组和高危组患者血清CD40L、PTX3水平显著高于低危组,高危组患者血清CD40L、PTX3水平显著高于中危组(P<0.05)。死亡组与存活组患者的性别、年龄、吸烟占比、患基础疾病占比、白细胞计数、白蛋白水平、血红蛋白水平比较差异无统计学意义(P>0.05);死亡组患者机械通气占比、血清CD40L和PTX3水平及APACHEⅡ评分均显著高于存活组(P<0.05)。Logistic回归分析结果显示,机械通气、血清CD40L和PTX3水平及APACHEⅡ评分为老年重症肺炎并呼吸衰竭患者死亡的危险因素(P<0.05)。以11.52μg·L^(-1)为最佳截断值,血清CD40L水平预测老年重症肺炎并呼吸衰竭患者死亡的灵敏度和特�Objective To investigate the changes of the levels of serum soluble CD40 ligand(CD40L)and pentraxin-3(PTX3)in elderly patients with severe pneumonia and respiratory failure and their clinical significance.Methods A total of 98 elderly patients with severe pneumonia and respiratory failure admitted to Nanyang First People's Hospital from January 2020 to January 2022 were selected as the research objects.The general clinical data including the age,gender,smoking,basic diseases(diabetes,coronary heart disease,hypertension,chronic obstructive pulmonary disease),mechanical ventilation,white blood cell count,serum albumin and hemoglobin were collected.The fasting peripheral venous blood of patients within 24 hours after admission was collected,and the serum CD40L and PTX3 levels were detected by enzyme-linked immunosorbent assay.The patients all underwent acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hours after admission,and the patients were divided into low-risk group(<10 points,n=25),medium-risk group(10-20 points,n=40)and high-risk group(>20 points,n=33)according to the APACHEⅡscore;the serum CD40L and PTX3 levels of patients were compared among the three groups.According to whether the patients died within 30 days after admission,the patients were divided into death group(n=69)and survival group(n=29);the serum CD40L and PTX3 levels,APACHEⅡscore and general clinical data of patients between the two groups were compared.The prognostic factors of patients were analyzed by logistic regression analysis,and the value of serum CD40L and PTX3 levels in predicting the prognosis of patients was analyzed by receiver operating characteristic(ROC)curve.Results There were significant differences in serum CD40L and PTX3 levels among the low-risk group,medium-risk group and high-risk group(F=28.690,199.407;P<0.05);the serum CD40L and PTX3 levels of patients in the medium-risk group and high-risk group were significantly higher than those in the low-risk group,while the serum CD40L and PTX3 leve

关 键 词：重症肺炎 呼吸衰竭 血清可溶性CD40配体 正五聚体蛋白-3 

分 类 号：R653.1[医药卫生—外科学]