血清SAA、IL-18、IL-10、IL-1Ra联合检测对重症肺部感染并发脓毒症患者预后的预测价值  

Prognostic value of joint detection of serum SAA,IL-18,IL-10 and IL-1Ra in patients with severe pulmonary infection and sepsis

作　　者：王珏 孙建梅[1] 徐曼[2] 王金芝 郑红[4] WANG Jue;SUN Jianmei;XU Man;WANG Jinzhi;ZHENG Hong(Medical Laboratory,Baoding NO.1 Central Hospital,Baoding,Hebei 071000,China;Department of Critical Care Medicine,Baoding NO.1 Central Hospital,Baoding,Hebei 071000,China;Internal Medicine Department,Zhuozhou Traditional Chinese Medicine Hospital,Zhuozhou,Hebei 072750,China;Outpatient Department,Baoding NO.1 Central Hospital,Baoding,Hebei 071000,China)

机构地区：[1]保定市第一中心医院医学检验科,河北保定071000 [2]保定市第一中心医院重症医学科,河北保定071000 [3]涿州市中医医院内科,河北涿州072750 [4]保定市第一中心医院门诊部,河北保定071000

出　　处：《热带医学杂志》2025年第2期228-231,共4页Journal of Tropical Medicine

基　　金：河北省医学科学研究项目(20221605);保定市计划项目(2441ZF062)。

摘　　要：目的分析血清淀粉样蛋白A(SAA)、白细胞介素-18(IL-18)、白细胞介素-10(IL-10)、白细胞介素-1受体拮抗剂(IL-1Ra)联合检测对重症肺部感染并发脓毒症患者预后的预测价值,为临床提供参考。方法选取保定市第一中心医院2022年1月-2023年12月收治的82例重症肺部感染并发脓毒症患者,并依据患者预后情况进行分组,病情好转或未恶化的41例患者为存活组,死亡的41例患者为死亡组。比较两组患者临床资料、血清SAA、IL-18、IL-10、IL-1Ra水平,采用受试者工作特征(ROC)曲线分析血清SAA、IL-18、IL-10、IL-1Ra及联合监测对重症肺部感染并发脓毒症患者预后的预测价值。结果两组患者临床资料比较差异无统计学意义(P>0.05);死亡组患者SAA、IL-18、IL-10、IL-1Ra水平均高于存活组,差异均有统计学意义(t=4.123、5.744、4.003、4.610,P均<0.05)。经ROC分析,血清SAA、IL-18、IL-10、IL-1Ra预测重症肺部感染并发脓毒症患者预后的曲线下面积(AUC)分别为0.747(0.639~0.837)、0.820(0.720~0.896)、0.731(0.621~0.823)、0.769(0.663~0.855)。Logistic回归获得联合诊断模型,公式为Log(P)=-17.726+0.013×SAA+0.070×IL-18+0.024×IL-10+0.021×IL-1Ra,AUC为0.893(0.805~0.950),Z值为11.358,约登指数0.610,敏感度、特异度分别为80.49%、80.49%;联合预测效能显著高于SAA、IL-18、IL-10、IL-1Ra指标单独预测,差异均有统计学意义(Z=2.920、1.974、3.118、2.721,P=0.004、0.048、0.002、0.007)。结论不同预后的重症肺部感染并发脓毒症患者血清SAA、IL-18、IL-10、IL-1Ra均存在差异,且上述指标对患者预后具有一定预测价值,指标联合预测准确性更高。Objective To analyze the prognostic value of joint detection of serum amyloid A(SAA),interleukin-18(IL-18),interleukin-10(IL-10)and interleukin-1 receptor antagonist(IL-1Ra)in patients with severe pulmonary infection and sepsis,providing a reference for clinical.Methods A total of 82 patients with severe pulmonary infection and sepsis who were admitted to the Baoding NO.1 Central Hospital from January 2022 to December 2023 were enrolled in this study,and were grouped according to the prognosis.41 patients in improved or stable condition were included in the survival group.41dead patients were included in the death group.Clinical data,serum SAA,IL-18,IL-10 and IL-1Ra levels of the two groups were comparatively analyzed.The receiver operating characteristic(ROC)curves were used to analyze the prognostic value of serum SAA,IL-18,IL-10,IL-1Ra,and combination of these indicators in patients with severe pulmonary infection and sepsis.Results There was no statistically significant difference in clinical data between the two groups(P>0.05).The levels of SAA,IL-18,IL-10 and IL-1Ra in the death group were higher than those in the survival group(t=4.123,5.744,4.003,4.610;all P<0.05).ROC curve analysis showed that the area under the curve(AUC)values of serum SAA,IL-18,IL-10,and IL-1Ra for predicting the prognosis of patients with severe pulmonary infection and sepsis were 0.747(0.639-0.837),0.820(0.720-0.896),0.731(0.621-0.823),and 0.769(0.663-0.855),respectively.A prediction model was constructed based on logistic regression analysis and the formula was Log(P)=-17.726+0.013·SAA+0.070·IL-18+0.024·IL-10+0.021·IL-1Ra.The AUC,Z-value,Youden index,sensitivity and specificity of this model were 0.893(0.805-0.950),11.358,0.610,80.49% and 80.49%,respectively.The predictive performance of combination of SAA,IL-18,IL-10 and IL-1Ra was significantly better than each indicator(Z=2.920,1.974,3.118,2.721,P=0.004,0.048,0.002,0.007).Conclusion There were differences in serum SAA,IL-18,IL-10,and IL-1Ra levels among patients with severe

关 键 词：重症肺部感染 脓毒症 血清淀粉样蛋白A 白细胞介素-18 白细胞介素-10 白细胞介素-1受体拮抗剂 

分 类 号：R563[医药卫生—呼吸系统]