老年社区获得性肺炎患者血清suPAR、PTX3水平与疾病严重程度及死亡率的关系-东南大学学报医学版

老年社区获得性肺炎患者血清suPAR、PTX3水平与疾病严重程度及死亡率的关系

单位：广安市人民医院呼吸内科, 四川广安 638001

关键词：老年社区获得性肺炎可溶性尿激酶型纤溶酶原激活物受体正五聚蛋白3 疾病严重程度死亡率

分类号：R563.1

出版年·卷·期（页码）：2022·41·第二期（215-221）

摘要：

目的:研究老年社区获得性肺炎(CAP)患者血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、正五聚蛋白3(PTX3)水平与疾病严重程度及死亡率的关系。方法:选取2019年3月至2021年3月我院收治的240例老年CAP患者作为研究对象,包括79例重症CAP(sCAP)患者(为sCAP组)和161例非重症CAP患者(为非sCAP组)。采用酶联免疫吸附法检测血清suPAR和PTX3基线水平,计算CURB-65评分和肺炎严重指数(PSI)评分。随访30 d,记录患者死亡情况。使用受试者工作特征(ROC)曲线评价上述指标对CAP患者疾病严重程度和30 d死亡风险的预测能力。结果:与非sCAP组相比,sCAP组患者血清suPAR和PTX3水平显著升高(P＜0.05)。随访30 d,29例患者死亡,死亡患者血清suPAR和PTX3水平高于生存患者(P＜0.05)。经Spearman秩相关分析,血清suPAR、PTX3水平均与CURB-65评分、PSI评分呈正相关(P＜0.001)。ROC曲线分析显示,血清suPAR、PTX3水平用于诊断sCAP的曲线下面积(AUC)为0.904(0.866~0.942)、0.905(0.868~0.941),预测CAP患者30 d死亡的AUC为0.917(0.866~0.968)、0.936(0.900~0.973)。结论:入院时检测血清suPAR、PTX3水平有助于老年CAP患者的危险分层和预后预测。

Objective: To investigate the relationship between the serum soluble urokinase-type plasminogen activator receptor(suPAR), pentraxin-3(PTX3) and the disease severity and mortality in elderly patients with community-acquired pneumonia(CAP). Methods: From March 2019 to March 2021, 240 patients with CAP were selected as study subjects, including 79 patients with severe CAP(sCAP group) and 161 patients with non-severe CAP(non-sCAP group). The levels of serum suPAR and PTX3 were detected by enzyme-linked immunosorbent assay. CURB-65 score and pneumonia severity index(PSI) score were calculated based on clinical and laboratory data. The patients were followed up for 30 days and the cause of patients' death was documented. Receiver operating characteristic(ROC) curve were used to identify the severity of CAP patients and predict the 30-day mortality risk. Results: Compared with non-sCAP group, serum suPAR and PTX3 levels were significantly higher in sCAP group(P＜0.05). In addition, after 30 days' follow-up, it was found that 29 patients died and the serum suPAR and PTX3 levels in the dead patients were higher than those in the survivals(P＜0.05). Spearman rank correlation coefficient analysis showed that serum suPAR and PTX3 levels were positively correlated with CURB-65 score and PSI score(P＜0.001). ROC curve analysis results showed that the area under the curve(AUC) of serum suPAR and PTX3 levels on the diagnosis of sCAP was 0.904(0.866-0.942) and 0.905(0.868-0.941), and AUC of these levels on the prediction of 30 days' death was 0.917(0.866-0.968) and 0.936(0.900-0.973) respectively. Conclusion: Determination of serum suPAR and PTX3 levels at admission is helpful for risk stratification and prognosis prediction in elderly patients with CAP.

参考文献：

[1] RIDER A C,FRAZEE B W.Community-acquired pneumonia[J].Emerg Med Clin North Am,2018,36(4):665-683.
[2] 陈嘉琦,伍俊,叶国辉,等.GNRI、CPIS及炎症指标联合应用对老年社区获得性肺炎患者预后的预测价值[J].新医学,2021,52(8):633-636.
[3] 郑晓,郑永华,胡小燕,等.社区获得性肺炎患者血清suPAR、sTREM-1、TNF-α、IL-6变化及临床意义[J].临床荟萃,2021,36(4):323-327.
[4] HAMIE L,DAOUD G,NEMER G,et al.SuPAR,an emerging biomarker in kidney and inflammatory diseases[J].Postgrad Med J,2018,94(1115):517-524.
[5] TANG T,DAI Y,ZENG Q,et al.Pentraxin-3 polymorphisms and pulmonary fungal disease in non-neutropenic patients[J].Ann Transl Med,2020,8(18):1142.
[6] HE Q,LI H,RUI Y,et al.Pentraxin 3 gene polymorphisms and pulmonary aspergillosis in chronic obstructive pulmonary disease patients[J].Clin Infect Dis,2018,66(2):261-267.
[7] 瞿介明,曹彬.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[8] LEUNG A K C,WONG A H C,HON K L.Community-acquired pneumonia in children[J].Recent Pat Inflamm Allergy Drug Discov,2018,12(2):136-144.
[9] SCHOLL N,ROHDE G G U.Community-acquired pneumonia in the elderly[J].Pneumologie,2019,73(10):605-616.
[10] 孙印,韦海燕,何士杰.重症肺炎患者血清suPAR、sTREM-1水平变化及意义[J].山东医药,2017,57(22):59-60.
[11] 牛天林.hs-CRP、suPAR联合血培养在感染败血症患儿中的诊断意义探究[J].标记免疫分析与临床,2019,26(2):242-245.
[12] SCHULMAN H,NIWARD K,ABATE E,et al.Sedimentation rate and suPAR in relation to disease activity and mortality in patients with tuberculosis[J].Int J Tuberc Lung Dis,2019,23(11):1155-1161.
[13] HUANG Q,XIONG H,YAN P,et al.The diagnostic and prognostic value of suPAR in patients with sepsis:a systematic review and meta-analysis[J].Shock,2020,53(4):416-425.
[14] 李蓉蓉,俞培锋.血清suPAR、SPA和sICAM-1水平与细菌性肺炎病情相关性及预后预测价值[J].全科医学临床与教育,2021,19(5):424-427.
[15] WU X Y,LI K T,YANG H X,et al.Complement C1q synergizes with PTX3 in promoting NLRP3 inflammasome over-activation and pyroptosis in rheumatoid arthritis[J].J Autoimmun,2020,106(1):102336.
[16] 王朝媛,周琼,甘菊,等.PTX 3在重症肺炎患儿血清中的表达及其与症因子、预后的关系[J].标记免疫分析与临床,2020,27(12):2117-2121.
[17] 李志华,王小艳,李晓峰,等.suPAR联合PCT对脓毒症患者死亡率的评判价值[J].河南大学学报(医学版),2020,39(6):410-413,418.
[18] 李振国,曲红梅,吴杰,等.不同病情急性肺栓塞患者血清PTX-3、Copeptin、HP的变化及与预后的关系分析[J].广西医科大学学报,2021,38(1):144-149.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录