重症社区获得性肺炎不良预后的评价指标探析  

An Analysis of the Evaluation Index of the Poor Prognosis of Severe Community-acquired Pneumonia

作　　者：罗程程 孟湘禄 徐雨歆 袁玉 LUO Chengcheng;MENG Xianglu;XU Yuxin;YUAN Yu(Department of Child Care,Jiamusi Maternal and Child Health Hospital,Jiamusi 154000,China)

机构地区：[1]佳木斯市妇幼保健院儿保科,黑龙江佳木斯154000

出　　处：《标记免疫分析与临床》2024年第8期1481-1486,共6页Labeled Immunoassays and Clinical Medicine

基　　金：黑龙江省教育厅科学技术研究项目(编号:14251777)。

摘　　要：目的探讨基于临床肺部感染(clinical pulmonary infection score,CPIS)评分、痰细菌清除率、高迁移率蛋白1(high mobility group protein 1,HMGB1)、白细胞介素17(interleukin 17,IL-17)、白细胞介素23(interleukin 23,IL-23)的表达情况评价重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)患儿治疗作用的临床价值。方法选取本院2022年6月至2023年6月收治的社区获得性肺炎(community acquired pneumonia,CAP)患儿80例进行对照实验,根据受试者病情严重程度(CURB-65评分标准)分成轻度(0~1分)、中度(2分)、重度组(≥3分,即SCAP组),各26、27、27例。3组均单纯予以头孢噻肟钠(静脉滴注;轻度组,100mg/kg;中度组,150mg/kg,重度组,150mg/kg,均分2~4次滴注,疗程1周)治疗。统计治疗前、治疗1周时各组的痰细菌清除率、CPIS评分,利用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测治疗前后各组HMGB1、IL-17、IL-23表达水平,将上述各项资料纳入SPSS 23.0软件处理,探析痰细菌清除率、CPIS评分、HMGB1、IL-17、IL-23在不同组别中的差异,及其与患儿预后的相关性,并以此为基础分析这些指标单独与联合预测重症肺炎的价值。结果(1)CAP患儿病情越严重,痰细菌清除率越低,CPIS评分越高(P<0.05)。(2)治疗前HMGB1、IL-17、IL-23表达越高,SARS患儿病情越严重(P<0.001),治疗后SCAP患儿病情越轻,HMGB1、IL-17、IL-23表达越低(P<0.05)。(3)痰细菌清除率与CPIS评分呈显著的负相关(P<0.001),HMGB1、IL-17、IL-23与CPIS评分呈显著正相关(P<0.005)。(4)痰细菌清除率、CPIS评分、HMGB1、IL-17、IL-23联合检测的AUC值(最大为0.982,95%CI 0.851~0.995)依次高于HMGB1、IL-23、IL-17、痰细菌清除率和CPIS评分。结论本研究的创新点在于观察痰细菌清除率降低、CPIS评分、HMGB1、IL-17和IL-23综合评价SCAP患儿预后的作用,SCAP患儿的痰细菌清除率降低、CPIS评分升高,HMGB1、IL-17和IL-23呈异常表达,可作为SCAPObjective To investigate the clinical pulmonary infection score(CPIS),sputum bacterial clearance,High Mobility Group Protein 1(HMGB1),interleukin 17(IL-17),interleukin 23(IL-23)levels in Severe,community-acquired pneumonia,and to evaluate clinical value of therapeutic effect of SCAP in children.Methods A controlled experiment was conducted in 80 children with community acquired pneumonia(CAP)admitted to our hospital from June,2022 to June,2023.Subjects were divided into mild(0-1 points),moderate(2 points)and severe(≥3 points-SCAP group)according to the severity of their disease(CURB-65 score scale),with 26,27 and 27 cases in each group.All three groups were given cefotaxime sodium alone,intravenous infusion:Mild group,100mg/kg;Moderate group,150mg/kg;Severe group,150mg/kg,with 2 to 4 times during the course of 1 week treatment.Sputum bacterial clearance rate and CPIS score of each group were counted before and after 1 week of treatment.Enzyme-linked immunosorbent assay(ELISA)was used to detect expression levels of HMGB1,IL-17 and IL-23 in each group before and after treatment.The obtained dataset were incorporated into SPSS 23.0 software for processing,and the differences of sputum bacterial clearance,CPIS score,HMGB1,IL-17 and IL-23 in different groups were analyzed.Their correlations with the prognosis of children were evaluated and the value of these indicators in predicting severe pneumonia independently and jointly was analyzed.Results①The more severe the SCAP disease,the lower the sputum bacterial clearance,and the higher the CPIS score(P<0.05).②The higher the expression of HMGB1,IL-17,and IL-23 before treatment,the more severe the SCAP children were(P<0.001),and the less severe the SCAP children after treatment,the lower the expression of HMGB1,IL-17,and IL-23(P<0.05).③Sputum bacterial clearance showed a significant negative correlation with CPIS score(P<0.001),while HMGB1,IL-17 and IL-23 showed significant positive correlations with CPIS score(P<0.005).④AUC values of sputum bacterial clearance,C

关 键 词：痰细菌清除率 CPIS评分 高迁移率蛋白1 白细胞介素17 白细胞介素23 重症社区获得性肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]