血清及下呼吸道分泌物SLPI水平在ICU重症肺炎中的评估价值  

The evaluation value of serum and lower respiratory tract secretion SLPI in severe pneumonia in ICU

作　　者：武道荣[1] 闫雪波[2] 闻婷玉 宋秋鸣[1] WU Daorong;YAN Xuebo;WEN Tingyu;SONG Qiuming(Department of Intensive Care Unit,the Third Clinical College of Anhui Medical University(the Third Peoples Hospital of Heifei),Heifei 230022,China;不详)

机构地区：[1]安徽医科大学合肥第三临床学院(合肥市第三人民医院)重症医学科,合肥230022 [2]安徽医科大学第一附属医院干部呼吸与危重症医学科,合肥230021

出　　处：《实用医学杂志》2023年第12期1529-1535,共7页The Journal of Practical Medicine

基　　金：安徽省教育厅自然科学研究项目(编号:KJ2021A0279);合肥市卫健委新冠肺炎疫情防控科研项目基金(编号:HWK2020yb007);合肥市卫健委中医药研究项目(编号:合卫中医秘2021[12]号-15);合肥市第三人民医院课题基金(编号:SYKF202006)。

摘　　要：目的探讨血清及下呼吸道分泌物中分泌型白细胞蛋白酶抑制剂(SLPI)在重症肺炎中的评估价值。方法选取合肥市第三人民医院重症医学科(ICU)90例重症肺炎患者的临床资料,根据28 d生存情况分为存活组与死亡组,比较两组基线资料和入ICU及治疗24 h后的血清及下呼吸道分泌物SLPI、血清肿瘤坏死因子⁃α(TNF⁃α)及白细胞介素⁃8(IL⁃8)水平;分析血清SLPI与下呼吸道分泌物SLPI、TNF⁃α、IL⁃8的相关性;进行二分类logistic回归分析影响重症肺炎预后的影响因素;采用受试者工作特征(ROC)曲线分析血清及下呼吸道分泌物SLPI对重症肺炎预后的评估价值。结果死亡组机械通气时间长于存活组,余基线资料均差异无统计学意义(P>0.05)。治疗24 h后,两组血清及下呼吸道分泌物SLPI均较治疗前升高,血清TNF⁃α、IL⁃8均较治疗前降低(P<0.05)。存活组治疗后血清及下呼吸道分泌物SLPI均高于死亡组,血清TNF⁃α、IL⁃8均低于死亡组,(P<0.05)。Spearman相关性分析发现,血清SLPI与TNF⁃α、IL⁃8呈负相关(r=-0.583、-0.672,P<0.001);而与下呼吸道分泌物SLPI呈正相关(r=0.527,P<0.001)。二分类logistic回归分析显示血清及下呼吸道分泌物SLPI是重症肺炎28 d死亡的保护因素(P<0.05)。ROC曲线分析显示治疗后血清及下呼吸道分泌物SLPI的曲线下面积(AUC)分别为0.953、0.968,血清SLPI<87.59 ng/mL、下呼吸道分泌物SLPI<835.68 ng/mL时患者预后差(P<0.05);二者联合预测效能高于单独指标,AUC为0.991(P<0.05)。结论SLPI是重症肺炎的保护因素,血清及下呼吸道分泌物SLPI或可作为重症肺炎治疗及预后评估的有效指标。Objective To investigate the value of secretory leukocyte protease inhibitor(SLPI)in serum and lower respiratory tract secretion in severe pneumonia.Methods 90 patients with severe pneumonia from the Intensive Care Unit(ICU)of the Third People′s Hospital of Hefei were selected for clinical data.They were respectively divided into a survival group and a death group based on their28⁃day survival status.Baseline data,serum and lower respiratory tract secretions(SLPI)and serum Tumor necrosis factor⁃α(TNF⁃α),Interleukin⁃8(IL⁃8)levels were compared between the two groups at admission to ICU and after 24 hours treatment.Analyzing the correlation between serum SLPI and lower respiratory secretions SLPI,TNF⁃αand IL⁃8.Conduct binary logistic regression analysis on the influencing factors of prognosis for severe pneumonia.And used receiver operating characteristic(ROC)curve to analysis the evaluation value of patient serum and lower respiratory tract secretions(SLPI)for the prognosis of severe pneumonia.Results The mechanical ventilation time in the death group was longer than that in the survival group,and there was no significant difference in the remaining baseline data(P>0.05).After 24 hours of treatment,the serum and lower respiratory tract secretion SLPI of both groups increased compared to before,and serum TNF⁃α,IL⁃8 levels decreased(P<0.05).After treatment,the SLPI of serum and lower respira⁃tory tract secretions in survival group were higher than those in the death group,and the serum TNF⁃α,IL⁃8 levels were lower than those in the death group(P<0.05).Spearman correlation analysis found that serum SLPI and TNF⁃α,IL⁃8 showed a negative correlation(r=-0.583,-0.672,P<0.001);And there was a positive correlation with lower respiratory tract secretion SLPI(r=0.527,P<0.001).The binary logistic regression analysis showed that serum and lower respiratory tract secretions(SLPI)were protective factors for 28 day mortality in severe pneumonia(P<0.05).ROC curve analysis showed that the area un

关 键 词：分泌型白细胞蛋白酶抑制剂 肿瘤坏死因子⁃α 白细胞介素⁃8 重症肺炎 

分 类 号：R446[医药卫生—诊断学] R563.1[医药卫生—临床医学]