血清sCD163、sTWEAK水平与重症肺炎预后的关系  

Relationship between serum sCD163 and sTWEAK levels and prognosis of severe pneumonia

作　　者：张云龙 宋晓飞[2] 骆海霞 曹云云 ZHANG Yunlong;SONG Xiaofei;LUO Haixia;CAO Yunyun(Department of Critical Care Medicine,Shijiazhuang People's Hospital,Shijiazhuang 050011,China;Department of Otolaryngology Head and Neck Surgery,Hebei Provincial People's Hospital,Shijiazhuang 050011,China;The First Department of Cardiovascular Internal Medicine,Shijiazhuang People's Hospital,Shijiazhuang 050011,China)

机构地区：[1]石家庄市人民医院重症医学科,河北石家庄050011 [2]河北省人民医院耳鼻咽喉头颈外科,河北石家庄050011 [3]石家庄市人民医院心血管内一科,河北石家庄050011

出　　处：《东南大学学报（医学版）》2023年第3期398-404,共7页Journal of Southeast University(Medical Science Edition)

基　　金：石家庄市科学技术研究与发展计划项目(211201173)。

摘　　要：目的:分析重症肺炎(SP)患者血清可溶性血红蛋白清道夫受体(sCD163)、可溶性肿瘤坏死因子样凋亡微弱诱导剂(sTWEAK)与预后的关系。方法:选取2019年1月至2022年1月期间于石家庄市人民医院确诊并接受住院治疗的190例SP患者为研究组,根据SP患者住院后30 d内是否存活,将患者分为生存组(144例)和死亡组(46例);另选择石家庄市人民医院同期健康体检者190例为对照组。采用酶联免疫吸附法测定血清sCD163、sTWEAK表达水平。采用Pearson法分析SP患者血清中sCD163与sTWEAK表达的相关性;比较生存组与死亡组患者的一般临床资料;采用Logistic回归分析患者预后死亡的影响因素;采用ROC曲线分析血清sCD163、sTWEAK表达水平对患者预后死亡的预测价值。结果:对照组血清sCD163、sTWEAK表达水平明显低于研究组(P<0.05)。Pearson法分析显示,SP患者血清中sCD163表达与sTWEAK表达呈正相关(r=0.516,P<0.05)。生存组与死亡组患者的年龄、性别、体质指数、白细胞计数、血红蛋白、CRP、血小板、肌钙蛋白Ⅰ、PO_(2)及PCO_(2)差异均无统计学意义(P>0.05),COPD基础疾病史、全身性感染相关性功能衰竭评分(SOFA)、sCD163水平、sTWEAK水平差异有统计学意义(P<0.05),并且生存组患者SOFA、sCD163水平、sTWEAK水平均明显低于死亡组(P<0.05)。Logistic回归分析结果显示,sCD163水平(OR=4.540,95%CI为1.640~12.564)、sTWEAK水平(OR=3.974,95%CI为1.512~10.444)、SOFA(OR=8.185,95%CI为3.117~21.490)、COPD基础疾病史(OR=2.849,95%CI为1.080~7.514)是SP患者预后死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清sCD163、sTWEAK的截断值分别为295.71、198.72 pg·ml-1,血清sCD163、sTWEAK、二者联合预测SP患者预后死亡的AUC分别为0.830、0.807、0.891,特异度分别为95.83%、96.53%、87.50%,灵敏度分别为69.57%、54.35%、82.61%。结论:sCD163、sTWEAK在SP患者血清中呈高表达,是SP患者预后死亡的独立危险因�Objective:To analyze the relationship between serum soluble hemoglobin scavenger receptor(sCD163),soluble tumor necrosis factor-like weak apoptosis inducer(sTWEAK)and prognosis in patients with severe pneumonia(SP).Methods:From January 2019 to January 2022,190 SP patients who were diagnosed in our hospital and received inpatient treatment were taken as the study group.Depending on whether the patient is alive within 30 days of hospitalization,the patients were grouped into a survival group(144 cases)and a death group(46 cases);in addition,190 healthy people in our hospital were regarded as the control group.The expression levels of serum sCD163 and sTWEAK were determined by enzyme-linked immunosorbent assay.The correlation between sCD163 and sTWEAK expression in serum of SP patients was analyzed by Pearson analysis;the general clinical data of the patients in the survival group and the death group were compared;Logistic regression was applied to analyze the influencing factors of death of patients;ROC curve was applied to analyze the predictive value of serum sCD163 and sTWEAK expression levels for death of patients.Results:The expression levels of serum sCD163 and sTWEAK in the control group were significantly lower than those in the study group(P<0.05).Pearson analysis showed that the serum sCD163 expression in SP patients was positively correlated with sTWEAK expression(r=0.516,P<0.05).There were no significant differences in age,sex,body mass index,white blood cell count,hemoglobin,CRP,platelets,troponinⅠ,PO_(2)and PCO_(2)between the survival group and the death group(P>0.05),but there were statistically significant differences in COPD underlying disease history,SOFA,sCD163 level and sTWEAK level(P<0.05).SOFA,sCD163 level and sTWEAK level in the survival group were significantly lower than those in the death group(P<0.05).Logistic regression analysis showed that sCD163 level(OR=4.540,95%CI 1.640-12.564),sTWEAK level(OR=3.974,95%CI 1.512-10.444),SOFA(OR=8.185,95%CI 3.117-21.490),COPD underlying disease histo

关 键 词：重症肺炎 可溶性血红蛋白清道夫受体 可溶性肿瘤坏死因子样凋亡微弱诱导剂 预后 

分 类 号：R563.1[医药卫生—呼吸系统]