老年重症肺炎患者肺泡灌洗液中MMP-2、SPA表达水平对生存状况的预测价值分析-东南大学学报医学版

老年重症肺炎患者肺泡灌洗液中MMP-2、SPA表达水平对生存状况的预测价值分析

单位：南阳市第二人民医院呼吸内科, 河南南阳 473000

关键词：重症肺炎肺泡灌洗液基质金属蛋白酶2 肺表面活性物质相关蛋白A 生存预测价值

分类号：R563.1;R446

出版年·卷·期（页码）：2024·43·第六期（925-931）

摘要：

目的:探讨老年重症肺炎患者肺泡灌洗液中基质金属蛋白酶2(MMP-2)、肺表面活性物质相关蛋白A(SPA)表达水平对生存状况的预测价值。方法:选择本院2021年11月至2023年10月的98例老年重症肺炎患者作为重症组,以入院30 d生存状况将其分为死亡组(34例)和生存组(64例),选择同期入院治疗的95例轻度肺炎患者作为对照组。对重症组和对照组肺泡灌洗液中MMP-2、SPA水平,生存组和死亡组临床资料及肺泡灌洗液中MMP-2、SPA水平进行比较;Cox回归分析患者生存状况的影响因素;受试者工作特征(ROC)曲线分析肺泡灌洗液中MMP-2、SPA水平对患者生存状况的预测价值;Kaplan-Meier曲线分析MMP-2、SPA表达水平与患者生存率之间的关系。结果:重症组肺泡灌洗液中MMP-2水平高于对照组,SPA水平低于对照组(P＜0.05);生存组患者氧合指数高于死亡组(P＜0.05);生存组肺泡灌洗液中MMP-2水平低于死亡组,SPA水平高于死亡组(P＜0.05);肺泡灌洗液中MMP-2是老年重症肺炎患者死亡的危险因素,SPA为保护因素(P＜0.05);肺泡灌洗液中MMP-2联合SPA预测老年重症肺炎患者的生存情况效能高于各指标单独预测(Z_联合-MMP-2=4.158,P＜0.001,Z_联合-SPA=2.060,P=0.039);MMP-2低表达组生存率显著高于MMP-2高表达组(P＜0.05),SPA高表达组生存率显著高于SPA低表达组(P＜0.05)。结论:老年重症肺炎患者肺泡灌洗液中MMP-2水平升高,SPA水平降低,MMP-2联合SPA预测老年重症肺炎患者的生存情况效能高于单一指标的单独预测。

Objective: To explore the expression levels of matrix metalloproteinase-2(MMP-2) and pulmonary surfactant-associated protein A(SPA) in alveolar lavage fluid of elderly patients with severe pneumonia, and their predictive value for survival status. Methods: A total of 98 elderly patients with severe pneumonia in our hospital from November 2021 to October 2023 were regarded as the severe group. They were separated into a death group(34 cases) and a survival group(64 cases) based on their 30-day survival status after admission. 95 patients with mild pulmonary infection who were admitted for treatment were regarded as the control group. The levels of MMP-2 and SPA in alveolar lavage fluid were compared between the severe group and the control group, and the clinical data and levels of MMP-2 and SPA in alveolar lavage fluid were compared between the survival group and the death group; Cox regression was applied to analyze the influencing factors of patient survival status; receiver operating characteristic(ROC) curve was applied to analyze the predictive values of MMP-2 and SPA levels in alveolar lavage fluid on survival status; Kaplan-Meier curve was applied to analyze the relationship between MMP-2, SPA expression levels and patient survival rate. Results: The level of MMP-2 in the alveolar lavage fluid of the severe group was higher than that of the control group, and the SPA level was lower than that of the control group(P<0.05); the oxygenation index of patients in the survival group was higher than that in the death group(P<0.05); the MMP-2 level in the alveolar lavage fluid of the survival group was lower than that of the death group, and the SPA level was higher than that of the death group(P<0.05); MMP-2 in alveolar lavage fluid was a risk factor for death in elderly patients with severe pneumonia, while SPA was a protective factor(P<0.05); the efficacy of MMP-2 combined with SPA in predicting the survival of elderly patients with severe pneumonia in alveolar lavage fluid was higher than that predicted by various indicators alone(Z_{combination-MMP-2}=4.158, P<0.001; Z_{combination-SPA}=2.060, P=0.039); the survival rate of the MMP-2 low expression group was obviously higher than that of the MMP-2 high expression group(P<0.05), and the survival rate of the SPA high expression group was obviously higher than that of the SPA low expression group(P<0.05). Conclusion: MMP-2 level in the alveolar lavage fluid of elderly patients with severe pneumonia increases, while SPA level decreases. The efficacy of MMP-2 combined with SPA in predicting the survival of elderly patients with severe pneumonia is higher than that of a single indicator alone.

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