老年重症肺炎合并呼吸衰竭患者血清DcR3、GDF-15、HBP水平及其对病情、预后的影响  

Serum levels of DcR3,GDF-15,and HBP in elderly patients with severe pneumonia and respiratory failure and their eeffects on the condition and prognosis

作　　者：宋秉睿 王建洪 史丽娜 SONG Bingrui;WANG Jianhong;SHI Li'na(Department of Critical Care Medicine,Zhangjiakou First Hospital,Zhangjiakou Hebei 075000,China)

机构地区：[1]张家口市第一医院重症医学科,河北张家口075000 [2]青县中医医院重症医学科,河北沧州062650

出　　处：《中国急救复苏与灾害医学杂志》2024年第1期56-60,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省卫生健康委科研基金项目(编号:20221895)。

摘　　要：目的 探究老年重症肺炎(SP)合并呼吸衰竭(RF)患者血清诱骗受体3(DcR3)、生长分化因子-15(GDF-15)、肝素结合蛋白(HBP)水平及其对病情、预后的影响。方法 选取2020年9月—2022年2月在本院就诊治疗的老年SP合并RF患者128例为观察组研究对象,根据病情严重程度将其分为低危组42例、中危组54例和高危组32例,再根据预后情况将其分为生存组98例和死亡组30例;另选取同期在本院就诊治疗的未合并RF的老年SP患者128例为对照组研究对象。采用酶联免疫吸附法(ELISA)测定血清DcR3、GDF-15、HBP、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平;采用Pearson分析老年SP合并RF患者血清DcR3、GDF-15、HBP与TNF-α、IL-6、APACHEⅡ评分的相关性;采用多因素logistic回归分析老年SP合并RF患者死亡的影响因素;采用受试者工作特征(ROC)曲线评价血清DcR3、GDF-15、HBP水平在预测老年SP合并RF患者预后中的应用价值。结果 观察组血清DcR3、GDF-15、HBP水平较对照组均显著升高(P<0.05);老年SP合并RF患者血清DcR3、GDF-15、HBP水平随患者病情严重程度加重而呈现逐渐升高趋势(P<0.05);死亡组老年SP合并RF患者血清DcR3、GDF-15、HBP、TNF-α、IL-6水平以及APACHEⅡ评分较生存组均显著升高(P<0.05);Pearson相关分析显示,老年SP合并RF患者血清DcR3、GDF-15、HBP水平与TNF-α、IL-6、APACHEⅡ评分均呈正相关(P<0.05);多因素Logistic回归分析显示,高水平DcR3、GDF-15、HBP均为老年SP合并RF患者死亡的独立危险因素(P<0.05);ROC曲线分析显示,血清DcR3、GDF-15、HBP水平预测老年SP合并RF患者死亡的曲线下面积(AUC)分别为0.843、0.841、0.804,三者联合预测的AUC为0.943,均优于其单独预测(Z=2.258、2.303、2.653,P<0.05)。结论 老年SP合并RF患者血清DcR3、GDF-15、HBP水平均显著升高,且随其病情严重程度加重而升高,三者联合在预测老年SP合并RF患者预后中具有重要价值。Objective To investigate the serum levels of decoy receptor 3(DcR3),growth differentiation factor-15(GDF-15),and heparin binding protein(HBP)in elderly patients with severe pneumonia(SP)and respiratory failure(RF),and their evaluation value for the condition and prognosis.Methods A total of 128 elderly patients with SP and RF who were treated in our hospital from September 2020 to February 2022 were collected as the study subjects in the observation group,according to the severity of their condition,they were grouped into a low risk group of 42 cases,a medium risk group of 54 cases,and a high risk group of 32 cases,according to their prognosis,they were grouped into survival group(98 cases)and death group(30 cases);in addition,128 elderly SP patients without RF who were treated in our hospital were collected as the control group.Serum levels of DcR3,GDF-15,HBP,TNF-α,and IL-6 were measured by enzyme linked immunosorbent assay(ELISA);Pearson was applied to analyze the correlation between serum DcR3,GDF-15,HBP,TNF-α,IL-6,and APACHEⅡscore in elderly patients with SP and RF;multivariate Logistic regression was applied to analyze the influencing factors of death in elderly patients with SP and RF;the value of serum DcR3,GDF-15,and HBP levels in predicting the prognosis of elderly patients with SP and RF was evaluated using receiver operating characteristic curve(ROC).Results The levels of serum DcR3,GDF-15,and HBP in the observation group were obviously higher than those in the control group(P<0.05);the serum levels of DcR3,GDF-15,and HBP in elderly patients with SP and RF gradually increased with the severity of the disease(P<0.05);the levels of serum DcR3,GDF-15,HBP,TNF-α,IL-6,and APACHEⅡscore in elderly patients with SP and RF in the death group were obviously higher than those in the survival group(P<0.05);Pearson correlation analysis showed that serum DcR3,GDF-15,and HBP levels in elderly patients with SP and RF were positively correlated with TNF-α,IL-6,and APACHEⅡscore(P<0.05);multivariate Logistic reg

关 键 词：老年人 重症肺炎 呼吸衰竭 诱骗受体3 生长分化因子-15 肝素结合蛋白 病情 预后 

分 类 号：R563.1[医药卫生—呼吸系统] R563.8[医药卫生—内科学]