重症肺炎患者血清和肺泡灌洗液中白细胞介素-34水平变化及其预后评估价值  

Changes of interleukin-34 levels in serum and bronchoalveolar lavage fluid of patients with severe pneumonia and their prognostic value

作　　者：刘玉鑫 严永敏 任建科 汤建磊 薛社亮[5] 庄志方[1] 蔡润 周燕娟[1] LIU Yuxin;YAN Yongmin;REN Jianke;TANG Jianlei;XUE Sheliang;ZHUANG Zhifang;CAI Run;ZHOU Yanjuan(Respiratory and Critical Care Medicine Department,Wujin Hospital Affiliated to Jiangsu University,Changzhou,Jiangsu,213017;Central Laboratory,Wujin Hospital Affiliated to Jiangsu University,Changzhou,Jiangsu,213017;National Health Commission Key Laboratory for Family Planning Contraceptives,Shanghai Research Center for Family Planning Contraceptives and Devices,Shanghai Institute of Biomedicine and Technology,Shanghai,200237;Critical Care Medicine Department,Wujin Hospital Affiliated to Jiangsu University,Changzhou,Jiangsu,213017;Cardiovascular Medicine Department,Wujin Hospital Affiliated to Jiangsu University,Changzhou,Jiangsu,213017)

机构地区：[1]江苏大学附属武进医院呼吸与危重症医学科,江苏常州213017 [2]江苏大学附属武进医院中心实验室,江苏常州213017 [3]国家卫生健康委员会计划生育药具重点实验室/上海生殖健康药具工程技术研究中心/上海市生物医药技术研究院,上海200237 [4]江苏大学附属武进医院重症医学科,江苏常州213017 [5]江苏大学附属武进医院心血管内科,江苏常州213017

出　　处：《实用临床医药杂志》2024年第24期31-36,43,共7页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金面上项目(82272421);江苏大学2023年度医教协同创新基金项目(JDYY2023072);江苏省常州市卫生健康委重大科技项目(ZD201929)。

摘　　要：目的探讨重症肺炎患者血清和肺泡灌洗液中白细胞介素-34(IL-34)水平变化及其对预后的评估价值。方法选取66例重症肺炎患者(重症肺炎组)、35例非重症肺炎患者(非重症肺炎组)、27名健康体检成人(对照组)作为研究对象,并根据28 d生存情况将重症肺炎组患者进一步分为存活组38例和死亡组28例,分析各组对象的临床资料。绘制受试者工作特征(ROC)曲线,评估血清IL-34和肺泡灌洗液IL-34基因相对表达量对重症肺炎患者28 d内死亡的预测效能,并评估血清IL-34对重症肺炎的预测效能;绘制Kaplan-Meier生存曲线,采用Logrank检验比较累积生存率;采用Cox回归分析探讨重症肺炎患者28 d内死亡的危险因素。采用Pearson相关性分析法分析重症肺炎患者血清IL-34水平与肺泡灌洗液IL-34基因相对表达量的相关性。结果重症肺炎组血清IL-34水平高于非重症肺炎组,且非重症肺炎组血清IL-34水平高于对照组,差异有统计学意义(P<0.05);死亡组血清IL-34水平、肺泡灌洗液IL-34基因相对表达量均高于存活组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,血清IL-34水平、肺泡灌洗液IL-34基因相对表达量预测重症肺炎患者28 d内死亡的曲线下面积分别为0.908、0.878;血清IL-34水平预测重症肺炎的最佳截断值为129.9 pg/mL。多因素Cox回归分析结果显示,血清IL-34水平升高、肺泡灌洗液IL-34基因相对表达量增加是重症肺炎患者28 d内死亡的独立危险因素(P<0.05)。Kaplan-Meier生存分析结果显示,以129.9 pg/mL为截断值,血清IL-34高水平的重症肺炎患者的累积生存率低于IL-34低水平患者,差异有统计学意义(Log-rank P<0.001)。结论重症肺炎患者的血清IL-34水平显著升高,且肺泡灌洗液中IL-34基因相对表达量与血清IL-34水平呈正相关,两者均可作为预测重症肺炎患者28 d内死亡预后的指标。Objective To investigate the changes in interleukin-34(IL-34)levels in serum and bronchoalveolar lavage fluid(BALF)of patients with severe pneumonia and their prognostic value.Methods A total of 66 patients with severe pneumonia(severe pneumonia group),35 patients with non-severe pneumonia(non-severe pneumonia group),and 27 healthy adults(control group)were enrolled.The severe pneumonia group was further divided into survival group of 38 patients and non-survival group of 28 patients based on 28-day survival.Clinical data of all subjects were analyzed.Receiver operating characteristic(ROC)curves were plotted to assess the predictive power of serum IL-34 and relative IL-34 gene expression in BALF for 28-day mortality in patients with severe pneumonia,as well as the predictive power of serum IL-34 for severe pneumonia.Kaplan-Meier survival curves were plotted,and the Log-rank test was used to compare cumulative survival rates.Cox regression analysis was conducted to explore risk factors for 28-day mortality in patients with severe pneumonia.Pearson correlation analysis was used to assess the correlation between serum IL-34 levels and relative IL-34 gene expression in BALF of patients with severe pneumonia.Results Serum IL-34 levels were higher in the severe pneumonia group than those in the non-severe pneumonia group,and were higher in the non-severe pneumonia group than in the control group(P<0.05).Serum IL-34 levels and relative IL-34 gene expression in BALF were higher in the non-survival group than in the survival group(P<0.05).ROC curve analysis showed that the areas under the curve for predicting 28-day mortality in patients with severe pneumonia were 0.908 for serum IL-34 levels and 0.878 for relative IL-34 gene expression in BALF.The optimal cutoff value for serum IL-34 levels in predicting severe pneumonia was 129.9 pg/mL.Multivariate Cox regression analysis showed that increased serum IL-34 levels and increased relative IL-34 gene expression in BALF were independent risk factors for 28-day mortality in pa

关 键 词：重症肺炎 肺泡灌洗液 白细胞介素-34 预后 

分 类 号：R563.1[医药卫生—呼吸系统] R446[医药卫生—内科学] R319[医药卫生—临床医学]