血清sCD163、sTWEAK水平与重症肺炎预后的关系-东南大学学报医学版

血清sCD163、sTWEAK水平与重症肺炎预后的关系

单位：1. 石家庄市人民医院重症医学科, 河北石家庄 050011;
2. 河北省人民医院耳鼻咽喉头颈外科, 河北石家庄 050011;
3. 石家庄市人民医院心血管内一科, 河北石家庄 050011

分类号：R563.1

出版年·卷·期（页码）：2023·42·第三期（398-404）

摘要：

目的: 分析重症肺炎(SP)患者血清可溶性血红蛋白清道夫受体(sCD163)、可溶性肿瘤坏死因子样凋亡微弱诱导剂(sTWEAK)与预后的关系。方法: 选取2019年1月至2022年1月期间于石家庄市人民医院确诊并接受住院治疗的190例SP患者为研究组,根据SP患者住院后30 d内是否存活,将患者分为生存组(144例)和死亡组(46例);另选择石家庄市人民医院同期健康体检者190例为对照组。采用酶联免疫吸附法测定血清sCD163、sTWEAK表达水平。采用Pearson法分析SP患者血清中sCD163与sTWEAK表达的相关性;比较生存组与死亡组患者的一般临床资料;采用Logistic回归分析患者预后死亡的影响因素;采用ROC曲线分析血清sCD163、sTWEAK表达水平对患者预后死亡的预测价值。结果: 对照组血清sCD163、sTWEAK表达水平明显低于研究组(P<0.05)。Pearson法分析显示,SP患者血清中sCD163表达与sTWEAK表达呈正相关(r=0.516,P<0.05)。生存组与死亡组患者的年龄、性别、体质指数、白细胞计数、血红蛋白、CRP、血小板、肌钙蛋白Ⅰ、PO₂及PCO₂差异均无统计学意义(P＞0.05),COPD基础疾病史、全身性感染相关性功能衰竭评分(SOFA)、sCD163水平、sTWEAK水平差异有统计学意义(P<0.05),并且生存组患者SOFA、sCD163水平、sTWEAK水平均明显低于死亡组(P<0.05)。Logistic回归分析结果显示,sCD163水平(OR=4.540,95%CI为1.640~12.564)、sTWEAK水平(OR=3.974,95%CI为1.512~10.444)、SOFA (OR=8.185,95%CI为3.117~21.490)、COPD基础疾病史(OR=2.849,95%CI为1.080~7.514)是SP患者预后死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清sCD163、sTWEAK的截断值分别为295.71、198.72 pg·ml^-1,血清sCD163、sTWEAK、二者联合预测SP患者预后死亡的AUC分别为0.830、0.807、0.891,特异度分别为95.83%、96.53%、87.50%,灵敏度分别为69.57%、54.35%、82.61%。结论: sCD163、sTWEAK在SP患者血清中呈高表达,是SP患者预后死亡的独立危险因素,且血清sCD163、sTWEAK联合检测对SP患者预后预测具有较高的特异度,有望成为评估SP患者预后的血清学指标。

Objective: To analyze the relationship between serum soluble hemoglobin scavenger receptor(sCD163), soluble tumor necrosis factor-like weak apoptosis inducer(sTWEAK) and prognosis in patients with severe pneumonia(SP). Methods: From January 2019 to January 2022, 190 SP patients who were diagnosed in our hospital and received inpatient treatment were taken as the study group. Depending on whether the patient is alive within 30 days of hospitalization, the patients were grouped into a survival group(144 cases) and a death group(46 cases); in addition, 190 healthy people in our hospital were regarded as the control group. The expression levels of serum sCD163 and sTWEAK were determined by enzyme-linked immunosorbent assay. The correlation between sCD163 and sTWEAK expression in serum of SP patients was analyzed by Pearson analysis; the general clinical data of the patients in the survival group and the death group were compared; Logistic regression was applied to analyze the influencing factors of death of patients; ROC curve was applied to analyze the predictive value of serum sCD163 and sTWEAK expression levels for death of patients. Results: The expression levels of serum sCD163 and sTWEAK in the control group were significantly lower than those in the study group(P<0.05). Pearson analysis showed that the serum sCD163 expression in SP patients was positively correlated with sTWEAK expression(r=0.516, P<0.05). There were no significant differences in age, sex, body mass index, white blood cell count, hemoglobin, CRP, platelets, troponin Ⅰ, PO₂ and PCO₂ between the survival group and the death group(P>0.05), but there were statistically significant differences in COPD underlying disease history, SOFA, sCD163 level and sTWEAK level(P<0.05). SOFA, sCD163 level and sTWEAK level in the survival group were significantly lower than those in the death group(P<0.05). Logistic regression analysis showed that sCD163 level(OR=4.540, 95%CI 1.640-12.564), sTWEAK level(OR=3.974, 95%CI 1.512-10.444), SOFA(OR=8.185, 95%CI 3.117-21.490), COPD underlying disease history(OR=2.849, 95%CI 1.080-7.514) were independent risk factors for prognosis death in SP patients(P<0.05). ROC curve analysis results showed that the cutoff values of serum sCD163 and sTWEAK were 295.71 pg·ml^-1 and 198.72 pg·ml^-1, respectively, and the AUC of serum sCD163, sTWEAK and their combination in predicting the prognosis death of SP patients were 0.830, 0.807 and 0.891, respectively. The specificity and sensitivity were 95.83%, 96.53%, 87.50% and 69.57%, 54.35%, 82.61%, respectively. Conclusion: sCD163 and sTWEAK are highly expressed in the serum of SP patients, which are independent risk factors for the prognosis death of SP patients, and the combined detection of serum sCD163 and sTWEAK has high specificity in predicting the prognosis of SP patients, and they are expected to become serological indicators for evaluating the prognosis of SP patients.

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