血清KL-6、PTX3、HBP水平与老年重症肺炎合并呼吸衰竭患者预后的相关性  

Correlation of serum KL-6,PTX3,HBP and the prognosis of elderly patients with severe pneumonia complicated with respiratory failure

作　　者：宋秉睿 王建洪 史丽娜 李有亮 李欣 岳树春 SONG Bingrui;WANG Jianhong;SHI Lina;LI Youliang;LI Xin;YUE Shuchun(Department of Critical Care Medicine,Zhangjiakou First Hospital,Zhangjiakou,Hebei 075000,China;Department of Critical Care Medicine,Qingxian Traditional Chinese Medicine Hospital,Cangzhou,Hebei 062650,China)

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

出　　处：《检验医学与临床》2024年第16期2380-2384,2389,共6页Laboratory Medicine and Clinic

基　　金：河北省卫生健康委员会科研基金:项目(20221895)。

摘　　要：目的探讨血清涎液化糖链抗原(KL-6)、正五聚蛋白3(PTX3)、肝素结合蛋白(HBP)与老年重症肺炎合并呼吸衰竭患者预后的相关性。方法选取2021年12月至2023年5月在张家口市第一医院重症医学科就诊的老年重症肺炎合并呼吸衰竭患者372例作为研究对象,根据患者28 d后转归状况分为死亡组和生存组。采用酶联免疫吸附试验检测血清KL-6、PTX3、HBP水平;采用Pearson相关分析KL-6、PTX3、HBP水平与白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)水平及急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分的相关性;采用多因素Logistic回归分析老年重症肺炎合并呼吸衰竭患者预后的影响因素;绘制受试者工作特征(ROC)曲线分析血清KL-6、PTX3、HBP对老年重症肺炎合并呼吸衰竭患者预后的预测价值。结果随访28 d后,372例患者中生存312例(生存组),死亡60例(死亡组)。生存组患者血清KL-6、PTX3、HBP水平显著低于死亡组(P<0.05);两组患者ICU住院时间、机械通气时间、中性粒细胞计数、WBC、氧合指数(PaO_(2)/FiO_(2))、APACHEⅡ评分及血清PCT、CRP、白细胞介素-10水平比较,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,血清KL-6、PTX3、HBP水平与WBC、APACHEⅡ评分及血清PCT、CRP水平均呈正相关(P<0.05)。多因素Logistic回归分析结果显示,血清KL-6、PTX3、HBP、WBC、PCT、CRP水平是老年重症肺炎合并呼吸衰竭患者死亡的影响因素(P<0.05)。KL-6、PTX3、HBP联合预测老年重症肺炎合并呼吸衰竭患者死亡的曲线下面积(AUC)显著高于各指标单项检测的AUC(Z_(联合vs.KL-6)=4.590,P<0.001;Z_(联合vs.PTX3)=3.823,P=0.001;Z_(联合vs.HBP)=5.471,P<0.001)。结论老年重症肺炎合并呼吸衰竭患者血清KL-6、PTX3、HBP水平较高,且与患者预后关系密切,故KL-6、PTX3、HBP在评估老年重症肺炎合并呼吸衰竭患者的预后中具有重要作用。Objective To investigate the correlation of serum Krebs von den Lungen-6(KL-6),pentraxin 3(PTX3),heparin-binding protein(HBP)and the prognosis of elderly patients with severe pneumonia complicated with respiratory failure.Methods From December 2021 to May 2023,372 elderly patients with severe pneumonia complicated with respiratory failure enrolled in Department of Intensive Care Medicine of Zhangjiakou First Hospital were collected as research objects,who were divided into death group and survival group according to the prognosis after 28 days.Enzyme-linked immunosorbent assay was applied to detect serum levels of KL-6,PTX3,and HBP.Pearson correlation analysis was applied to analyze the correlation between KL-6,PTX3,HBP levels,white blood cell count(WBC)and levels of C-reactive protein(CRP),procalcitonin(PLT)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score.Multivariate Logistic regression analysis was applied to analyze the factors affecting prognosis.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum KL-6,PTX3,HBP levels for prognosis of patients with severe pneumonia complicated with respiratory failure.Results After 28 d of follow-up,among 372 patients,312 survived(survival group)and 60 died(death group).The serum levels of KL-6,PTX3 and HBP in the survival group were obviously lower than those in the death group(P<0.05).The differences in ICU length of stay,duration of mechanical ventilation,neutrophil counts and WBC,PaO_(2)/FiO_(2),APACHEⅡscore and PCT,CRP,interleukin-10 levels were statistically significant between the two groups(P<0.05).Pearson analysis results showed that serum levels of KL-6,PTX3 and HBP were positively correlated with WBC,APACHEⅡscore and PCT,CRP levels(P<0.05).Multivariate Logistic regression analysis showed that KL-6,PTX3,HBP,WBC,PCT and CRP were the influencing factors of death in elderly patients with severe pneumonia complicated with respiratory failure(P<0.05).The area under the curve(AUC)of KL-6,PTX3 and HBP c

关 键 词：Ⅱ型肺泡细胞表面抗原 正五聚蛋白3 肝素结合蛋白 老年 重症肺炎 呼吸衰竭 预后 

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