老年肺炎患者血清SAA PCT和FN RBP水平与病情严重程度及预后的关系  

Relationship between Serum SAA PCT FN RBP and Disease Severity Prognosis in Elderly Patients with Pneumonia

作　　者：王良慧[1] 马娣[1] 殷俊 李宇婷 周大勇[1] WANG Lianghui;MA Di;YIN Jun(The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Anhui Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院综合ICU,安徽合肥230031

出　　处：《河北医学》2024年第12期2049-2054,共6页Hebei Medicine

基　　金：安徽省临床医学研究转化专项项目,(编号:202304295107020124)。

摘　　要：目的:分析老年肺炎患者血清淀粉样蛋白a(SAA)、降钙素原(PCT)和血浆纤维结合蛋白(FN)、视黄醇结合蛋白(RBP)水平与病情严重程度及预后的关系。方法:回顾性分析2021年4月至2024年4月于本院收治的85例老年肺炎患者的临床资料,根据患者预后情况将其分为预后良好组(60例)和预后不良组(25例)。比较两组入院后血液指标[PCT、SAA、RBP、血红蛋白(Hb)、纤维结合蛋白(FN)、白蛋白(ALB)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、β2微球蛋白]水平,血细胞[白细胞计数(WBC)、中性粒细胞比例、淋巴细胞比例、血小板]水平、血气指标[氧分压(PO_(2))、二氧化碳分压(PCO_(2))、血碳酸氢根离子浓度(HCO_(3)^(-))、碱剩余值(BE)、血乳酸浓度(Lac)]水平和急性生理与慢性健康评分系统(APACHEⅡ)评分;采用Spearman相关性分析患者相关血液指标和APACHEⅡ评分之间的相关性;采用Logistic回归分析影响老年肺炎患者预后情况的血液指标;采用ROC曲线分析相关指标对患者预后的预测价值。结果:预后不良组血PCT、SAA、IL-6、hs-CRP、RBP和β2微球蛋白水平均较预后良好组更高,ALB和FN水平较预后良好组更低(P<0.05);预后不良组APACHEⅡ评分更高(P<0.05)。Spearman相关性分析结果显示,血PCT、SAA和RBP水平均与APACHEⅡ评分呈正相关,FN水平与APACHEⅡ评分呈负相关(P<0.05)。Logistic回归分析结果显示,血PCT、SAA、FN和RBP均是老年影响肺炎患者预后的相关因素(P<0.05)。ROC曲线分析结果显示,血PCT(AUC=0.819)、SAA(AUC=0.775)、FN(AUC=0.792)和RBP(AUC=0.736)均对老年肺炎患者预后有良好的预测价值(P<0.05)。结论:老年肺炎患者血SAA、PCT、RBP水平越高,FN水平越低,患者病情越严重,预后越差,且上述四指标均对老年肺炎患者预后具有良好的预测价值。Objective:To analyze the relationship between serum amyloid a(SAA),procalcitonin(PCT),plasma fibronectin(FN),retinol binding protein(RBP)and disease severity,prognosis in elderly patients with pneumonia.Methods:A retrospective analysis was performed on the clinical data of 85 elderly patients with pneumonia in the hospital between April 2021 and April 2024.According to prognosis,patients were divided into good prognosis group(60 cases)and poor prognosis group(25 cases).After admission,levels of blood indexes[PCT,SAA,RBP,hemoglobin(Hb),FN,albumin(ALB),interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),β2 microglobulin],hemocytes[white blood cell count(WBC),neutrophil ratio,lymphocyte ratio,platelets]and blood gas indexes[partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),bicarbonate ion concentration(HCO_(3)^(-)),base excess(BE),blood lactate concentration(Lac)],and scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ)were compared between the two groups.The correlation between blood indexes and APACHEⅡscore was analyzed by Spearman correlation analysis.The blood indexes affecting the prognosis of elderly patients with pneumonia were analyzed with Logistic regression analysis.The prognostic value of relevant indexes was analyzed with ROC curves.Results:The levels of PCT,SAA,IL-6,hs-CRP,RBP andβ2 microglobulin in the poor prognosis group were higher than those in the good prognosis group,and the levels of ALB and FN were lower than those in the good prognosis group(P<0.05).APACHEⅡscore was higher in poor prognosis group(P<0.05).The results of Spearman correlation analysis showed that levels of serum PCT,SAA and RBP were positively correlated with APACHEⅡscore,while FN level was negatively correlated with it(P<0.05).The results of Logistic regression analysis showed that serum PCT,SAA,FN and RBP were all influencing factors of prognosis in elderly patients with pneumonia(P<0.05).The results of ROC curves analysis showed that serum PCT(AUC=0.819),SAA(AUC

关 键 词：肺炎 血液指标 老年 病情严重程度 预后 

分 类 号：R563.1[医药卫生—呼吸系统]