外周血乳酸变化率、D-二聚体、可溶性血红蛋白清道夫受体与重症肺炎病情和预后的关系  

Relationship between the peripheral blood lactate change rate,D-dimer,soluble haemoglobin scavenger receptor to the condition and prognosis of severe pneumonia

作　　者：张静 刘振来 聂晓琳 王丽丽 张瑞 于海红 ZHANG Jing;LIU Zhenlai;NIE Xiaolin;WANG Lili;ZHANG Rui;YU Haihong(Department of Respiratory Medicine,Chaoyang Second Hospital,Chaoyang 122000,China)

机构地区：[1]辽宁省朝阳市第二医院呼吸内科,辽宁省朝阳市122000

出　　处：《中国煤炭工业医学杂志》2025年第1期69-74,共6页Chinese Journal of Coal Industry Medicine

基　　金：辽宁省科学技术计划项目(编号:2018020130-314)。

摘　　要：目的探究外周血乳酸变化率、D-二聚体(D-D)、可溶性血红蛋白清道夫受体(sCD163)与重症肺炎病情和预后的关系。方法选取朝阳市第二医院2019年1月-2021年1月120例重症肺炎患者作为研究对象,比较不同病情程度患者外周血乳酸变化率、D-D、sCD163水平,分析各外周血指标与病情程度的关系,随访30d,按照预后情况将98例生存患者纳入生存组,22例死亡患者纳入死亡组。比较两组临床资料及外周血乳酸变化率、D-D、sCD163水平,分析各外周血指标对预后的影响及预测预后的价值。结果极危重症患者外周血乳酸变化率、D-D、sCD163为(5.78±1.31)%、(5.09±1.53)mg/L、(165.87±42.18)ng/L,高于危重症患者的(4.57±1.12)%、(3.87±0.84)mg/L、(137.06±31.52)ng/L、非危重症患者的(3.49±0.72)%、(3.01±0.51)mg/L、(108.25±18.96)ng/L,危重症患者高于非危重症患者(F=30.192、30.817、22.073,均P<0.001);Spearman相关性分析,外周血乳酸变化率、D-D、sCD163与病情程度呈正相关(r=0.643、0.679、0.660,均P<0.001);Logistic回归分析,外周血乳酸变化率、D-D、sCD163是重症肺炎病情程度的重要影响因素(均P<0.05);死亡组非危重症、危重症、急危重症比例(18.18%、45.45%、36.36%)与生存组的(51.02%、31.63%、17.35%)比较,差异有统计学意义(U=8.429,P=0.015),死亡组病程(10.13±2.77)d、住院时间(18.41±2.50)d长于生存组(6.59±2.19)d、(14.06±2.39)d(t=6.513、7.651,均P<0.001),死亡组糖尿病比例(27.27%)、机械通气(100.00%)、多器官功能衰竭比例(45.45%)、并发症比例(40.91%)、外周血乳酸变化率(6.78±2.69)%、D-D(5.83±2.35)mg/L、sCD163(186.07±44.61)ng/L高于生存组6.12%、72.45%、18.37%、20.41%、(4.12±1.38)%、(3.54±1.21)mg/L、(126.35±32.04)ng/L(x²=6.735、6.321、7.211、4.120,t=6.659、6.565、7.313,P=0.010、0.012、0.007、0.042、<0.001、<0.001、<0.001);Cox回归分析,将病程、糖尿病、机械通气、多器官功能衰竭、病情程度、住院Objective To explore the relationship between the peripheral blood lactate change rate,D-dimer(D-D),soluble hemoglobin scavenger receptor(sCD163)to the condition and prognosis of severe pneumonia.Methods A total of 120 patients with severe pneumonia in the Second Hospital of Chaoyang city from January 2019 to January 2021 were selected as the research objects.The peripheral blood lactate change rate,DD,and sCD163 levels of patients with different disease levels were compared,and the relationship between various peripheral blood indicators and the disease condition was analyzed.At 30 d of follow-up,98 surviving patients were included in the survival group,and 22 deceased patients were included in the death group according to their prognosis.The clinical data of the two groups were compared with the change rate of peripheral blood lactic acid,D-D,and sCD163 levels,and the influence of each peripheral blood index on the prognosis and the value of predicting the prognosis were analyzed.Results The peripheral blood lactate change rate,D-dimer,and sCD163 levels in extremely critically ll patients were(5.78±1.31)%,(5.09±1.53)mg/L,and(165.87±42.18)ng/L,respectively,which were higher than those in critically ll patients(4.57±1.12)%,(3.87±0.84)mg/L,and(137.06±31.52)ng/L,and non-critically ill patients(3.49±0.72)%,(3.01±0.51)mg/L,and(108.25±18.96)ng/L.Critically ill patients were higher than non-critically ill patients(F=30.192,30.817,22.073,P<0.001).Spearman correlation analysis showed that the peripheral blood lactate change rate,D-D,and sCD163 were positively correlated with the severity of the disease(r=0.643,0.679,0.660,all P<0.001).Logistic regression analysis showed that the peripheral blood lactate change rate,D-D,and sCD163 were important factors affecting the severity of severe pneumonia(P<0.05).The proportions of non-critical,critical,and extremely critical patients in the death group(18.18%,45.45%,and 36.36%)were significantly different from those in the survival group(51.02%,31.63%,and 17.35%)(U=8.429,

关 键 词：重症肺炎 乳酸变化率 D-二聚体 可溶性血红蛋白清道夫受体 病情程度 预测预后 

分 类 号：R563.1[医药卫生—呼吸系统]