肺泡灌洗液肝素结合蛋白、白细胞介素-17A水平预测老年重症肺炎患者预后的价值  

Value of heparin-binding protein and interleukin-17A levels in bronchoalveolar lavage fluid in predicting prognosis of elderly patients with severe pneumonia

作　　者：郭昌鹏 胡晓华 程龙 任志国 GUO Changpeng;HU Xiaohua;CHENG Long;REN Zhiguo(Department of Respiratory Medicine,the 971st Hospital of Navy of the Chinese People′s Liberation Army,Qingdao,Shandong,266000)

机构地区：[1]中国人民解放军海军第九七一医院呼吸内科,山东青岛266000

出　　处：《实用临床医药杂志》2025年第3期99-103,共5页Journal of Clinical Medicine in Practice

基　　金：山东省优秀中青年科学家科研奖励基金项目(BS2022SW0389)。

摘　　要：目的分析肺泡灌洗液肝素结合蛋白(HBP)、白细胞介素-17A(IL-17A)水平预测老年重症肺炎患者预后的价值。方法选取本院2022年5月—2024年5月收治的105例老年重症肺炎患者,根据入院28 d内生存结局分为死亡组32例和生存组73例。比较2组肺泡灌洗液HBP、IL-17A水平;采用Logistic回归分析探讨老年重症肺炎患者预后的影响因素;绘制受试者工作特征(ROC)曲线,分析肺泡灌洗液HBP、IL-17A对老年重症肺炎患者预后的预测效能。结果死亡组肺泡灌洗液HBP、IL-17A水平高于生存组,差异有统计学意义(P<0.01)。2组急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血乳酸(Lac)比较,差异有统计学意义(P<0.01)。Logistic回归分析显示,HBP(OR=3.084,95%CI:1.326~4.694)、IL-17A(OR=4.521,95%CI:2.164~7.841)、APACHEⅡ评分(OR=2.039,95%CI:1.069~2.859)、Lac(OR=2.627,95%CI:1.168~3.058)是老年重症肺炎患者预后的影响因素(P<0.05)。HBP最佳临界值取15.92 ng/mL、IL-17A最佳临界值取109.34 pg/mL时,肺泡灌洗液HBP、IL-17A联合预测老年重症肺炎患者预后的曲线下面积(AUC)为0.852,95%CI为0.801~0.948,肺泡灌洗液HBP、IL-17A联合预测老年重症肺炎患者预后的AUC高于单一检测(Z=2.906、2.416,P=0.007、0.014)。结论肺泡灌洗液HBP、IL-17A增高,APACHEⅡ评分降低,以及Lac增高是老年重症肺炎患者预后的影响因素,联合检测肺泡灌洗液HBP、IL-17A在预测老年重症肺炎患者预后方面的灵敏度较高。Objective To analyze the value of heparin-binding protein(HBP)and interleukin-17A(IL-17A)levels in bronchoalveolar lavage fluid in predicting prognosis of elderly patients with severe pneumonia.Methods A total of 105 elderly patients with severe pneumonia in the hospital from May 2022 to May 2024 were selected and divided into death group(n=32)and survival group(n=73)based on their survival outcomes within 28 days after admission.The levels of HBP and IL-17A in bronchoalveolar lavage fluid were compared between the two groups;the Logistic regression analysis was conducted to explore the influencing factors for prognosis in elderly patients with severe pneumonia;the receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficiencies of HBP and IL-17A in bronchoalveolar lavage fluid for the prognosis of elderly patients with severe pneumonia.Results The levels of HBP and IL-17A in bronchoalveolar lavage fluid in the death group were significantly higher than those in the survival group(P<0.01).There were significant differences in the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score and blood lactate(Lac)level between the two groups(P<0.01).Logistic regression analysis showed that HBP(OR=3.084,95%CI,1.326 to 4.694),IL-17A(OR=4.521,95%CI,2.164 to 7.841),APACHEⅡscore(OR=2.039,95%CI,1.069 to 2.859),and Lac(OR=2.627,95%CI,1.168 to 3.058)were influencing factors for the prognosis of elderly patients with severe pneumonia(P<0.05).When the optimal cut-off values were set at 15.92 ng/mL for HBP and 109.34 pg/mL for IL-17A,the area under the curve(AUC)for the combined prediction of prognosis by HBP and IL-17A in bronchoalveolar lavage fluid was 0.852,with a 95%CI of 0.801 to 0.948.The AUC for the combined prediction of prognosis by HBP and IL-17A in bronchoalveolar lavage fluid was significantly higher than that for single tests(Z=2.906,2.416,P=0.007,0.014).Conclusion Increased levels of HBP and IL-17A in bronchoalveolar lavage fluid,decreased APACHEⅡscore,and increased Lac ar

关 键 词：肺泡灌洗液 肝素结合蛋白 白细胞介素-17A 老年人群 重症肺炎 预后 

分 类 号：R563.1[医药卫生—呼吸系统] R592[医药卫生—内科学] R446.11[医药卫生—临床医学]