血清VEGF和Fn对VAP患者预后不良的预测价值  

Predictive value of serum VEGF and Fn for poor prognosis in patients with VAP

作　　者：齐连振 郭会莉 林庆华[1] 柴瑞丽 QI Lianzhen;GUO Huili;LIN Qinghua;CHAI Ruili(Department of Critical Care Medicine,the Second Affiliated Hospital of Xingtai Medical College,Xingtai,Hebei 054000,China;Department of Critical Care Medicine,Xingtai People′s Hospital,Xingtai,Hebei 054001,China)

机构地区：[1]邢台医学高等专科学校第二附属医院重症医学科,河北邢台054000 [2]河北省邢台市人民医院重症医学科,河北邢台054001

出　　处：《检验医学与临床》2024年第18期2711-2716,2723,共7页Laboratory Medicine and Clinic

基　　金：河北省邢台市重点研发计划项目(2022ZC183)。

摘　　要：目的探讨血清血管内皮生长因子(VEGF)和黏连蛋白(Fn)在不同时间对呼吸机相关肺炎(VAP)患者预后不良的预测价值。方法回顾性分析2020年1月至2023年12月在邢台医学高等专科学校第二附属医院就诊的242例VAP患者的病历资料。记录患者入院第1、3、5天血清VEGF、Fn水平,根据急性生理学和慢性健康状况(APACHE)Ⅱ评分将所有患者分成低危组(<10分)、中危组(10~20分)和高危组(>20分)。在患者出院28 d后进行随访,根据生存情况分为存活组与死亡组。采用Pearson相关分析VAP患者入院第3、5天血清VEGF、Fn水平与APACHEⅡ评分的相关性。采用多因素Logistic回归分析VAP患预后不良的危险因素。绘制受试者工作特征(ROC)曲线分析血清VEGF、Fn对VAP患者死亡的预测价值。结果低、中、高危组的患者分别有84、101、57例。中、高危组不同时间VEGF水平比较结果显示,入院第1天<入院第3天<入院第5天(P<0.05)。多变量方差分析结果显示,入院第3、5天高危组VEGF水平高于中危组和低危组(F=36.075、43.523,P<0.05)。低、中危组不同时间Fn水平比较结果显示,入院第1天<入院第3天<入院第5天(P<0.05)。入院第3、5天高危组Fn水平低于中危组和低危组(F=19.907、60.326,P<0.05)。入院第3、5天血清VEGF水平分别与APACHEⅡ评分呈正相关(r=0.433、0.519,P<0.001),入院第3、5天血清Fn水平分别与APACHEⅡ评分呈负相关(r=-0.384、-0.602,P<0.001)。存活组和死亡组分别有171、71例患者。死亡组和存活组APACHEⅡ评分、低密度脂蛋白、高密度脂蛋白水平比较,差异均有统计学意义(P<0.05)。死亡组不同时间VEGF水平比较结果显示,入院第1天<入院第3天(P<0.05)。多变量方差分析结果显示,入院第3、5天死亡组VEGF水平高于存活组(F=11.034、10.245,P<0.05)。存活组和死亡组不同时间Fn水平比较结果显示,入院第1天<入院第3天(P<0.05)。入院第3、5天死亡组Fn水平低于存�Objective To investigate the predictive value of serum vascular endothelial growth factor(VEGF)and adhesion protein(Fn)in the poor prognosis of patients with ventilator-associated pneumonia(VAP)at different times.Methods The medical records of 242 VAP patients in the Second Affiliated Hospital of Xingtai Medical College from January 2020 to December 2023 were retrospectively analyzed.Serum VEGF and Fn levels were recorded on the 1st,3rd and 5th day of admission,and all patients were divided into low risk group(<10 points),medium risk group(10-20 points)and high risk group(>20 points)according to acute physiology and chronic health status(APACHE)Ⅱscores.The patients were followed up 28 days after discharge and were divided into survival group and death group according to their survival status.Pearson correlation was used to analyze the correlation between serum VEGF and Fn levels and APACHEⅡscores on the 3rd and 5th day of admission in VAP patients.Multivariate Logistic regression was used to analyze the risk factors of poor prognosis in VAP patients.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum VEGF and Fn in death of VAP patients.Results There were 84,101 and 57 patients in low risk group,medium risk group and high risk groups respectively.The comparison of VEGF levels at different times between middle and high risk groups showed that the 1st day of admission was<the 3rd day of admission<the 5th day of admission(P<0.05).The results of multivariate analysis of variance showed that the levels of VEGF in high risk group were higher than those in medium risk group and low risk group on the 3rd and 5th day after admission(F=36.075,43.523,P<0.05).The comparison of Fn levels at different times between low and medium risk groups showed that the 1st day of admission was<the 3rd day of admission<the 5th day of admission(P<0.05).On the 3rd and 5th day of admission,Fn levels in high risk group were lower than those in medium risk group and low risk group(F=19.907,60.326,P

关 键 词：血管内皮生长因子 黏连蛋白 呼吸机相关肺炎 病情严重程度 预后 

分 类 号：R825.6[医药卫生—临床医学] R446.1