白细胞介素-33联合降钙素原预测老年重症肺炎患者不良预后的临床效能

Clinical efficacy of IL-33 combined with procalcitonin in predicting the incidence of poor prognosis in elderly patients with severe pneumonia

目的探讨白细胞介素(IL)-33联合降钙素原预测老年重症肺炎患者发生不良预后的临床效能。方法选取河南省南阳市中心医院120例老年重症肺炎患者,根据治疗结果分为预后良好组(n=43)和预后不良组(n=77)。分析2组患者入院时基线参数及血清IL-33表达水平的差异。Logistic回归分析重症肺炎患者发生不良预后的危险因素;IL-33和降钙素原的相关性采用Pearson相关分析。IL-33及降钙素原预测老年重症肺炎患者发生不良预后的临床效能采用ROC曲线分析。结果与预后良好组相比,预后不良组入院时急性生理与慢性健康评分(APACHEⅡ)评分、白细胞、中性粒细胞、超敏C反应蛋白(hs-CRP)、降钙素原等水平升高,差异具有统计学意义(P<0.05)。预后良好组和预后不良组入院时血清中IL-33表达水平分别为(57±5)ng/ml和(98±7)ng/ml,差异有统计学意义(t=32.767,P<0.01)。多因素Logistic回归分析结果显示,降钙素原(OR=2.317)和IL-33(OR=2.895)均是重症肺炎患者发生不良预后的独立危险因素。120例重症肺炎患者血清IL-33和降钙素原水平分别为(76±6)ng/ml和(0.94±0.13)ng/ml,相关分析显示,IL-33与降钙素原呈正相关(r=0.631,P<0.05)。IL-33预测重症肺炎患者发生不良预后的曲线下面积(AUC)为0.896,当截断值为87.12 ng/ml,诊断敏感度和特异度分别为91.65%和92.23%;降钙素原预测重症肺炎患者发生不良预后的AUC为0.851,当截断值为0.98 ng/ml,诊断敏感度和特异度分别为89.34%和90.22%;IL-33联合降钙素原预测重症肺炎患者发生不良预后的AUC为0.974,诊断敏感度和特异度分别为96.33%和95.28%。结论IL-33与老年重症肺炎患者发生不良预后密切相关,IL-33联合降钙素原预测老年重症肺炎患者发生不良预后的临床效能显著。

Objective To investigate the clinical efficacy of IL-33 combined with procalcitonin in predicting the incidence of poor prognosis in elderly patients with severe pneumonia.Methods A total of 120 elderly patients with severe pneumonia were enrolled in Nanyang Central Hospital and divided into the well prognosis group(n=43)and the poor prognosis group(n=77)according to 10 days of treatment.The difference in baseline parameters and serum IL-33 expression levels on admission between the two groups were compared and analyzed.The poor prognosis risk factors in patients with severe pneumonia patients were analyzed by Logistic regression analysis.The correlation between IL-33 and procalcitonin was analyzed by Pearson methods.The clinical efficacy of IL-33 combined with procalcitonin in predicting the incidence of poor prognosis in elderly patients with severe pneumonia was analyzed by the ROC curve.Results Compared with the good prognosis group,the levels of APACHEⅡscore,leukocyte,neutrophil,hs-CRP and procalcitonin in the poor prognosis group were significantly higher,with statistical significance(P<0.05).Serum IL-33 expression levels in the well and poor prognosis group were(57±5)ng/ml and(98±7)ng/ml,respectively.Compared with the well-prognosis group,serum IL-33 expression levels in the poor-prognosis group were significantly higher(t=32.767,P<0.01).The Logistic regression analysis showed that procalcitonin(OR=2.317)and IL-33(OR=2.895)were independent risk factors for poor prognosis in patients with severe pneumonia.Serum levels of IL-33 and procalcitonin in 120 patients with severe pneumonia were(76±6)ng/ml and(0.94±0.13)ng/ml,respectively.The correlation analysis showed that there was a significant positive correlation between IL-33 and procalcitonin(r=0.631,P<0.05).The AUC of IL-33 in predicting the incidence of poor prognosis in elderly patients with severe pneumonia was 0.896,when the Cut-off value was 87.12 ng/ml,the sensitivity and specificity were 91.65%and 92.23%,respectively.The AUC of procalcitonin in predicting the incidence of poor prognosis in elderly patients with severe pneumonia was 0.851,when the Cut-off value was 0.98 ng/ml,the sensitivity and specificity were 89.34%and 90.22%,respectively.The AUC of IL-33 combined with procalcitonin in predicting the incidence of poor prognosis in elderly patients with severe pneumonia was 0.974,and diagnostic sensitivity and specificity were 96.33%and 95.28%,respectively.Conclusion IL-33 was related to poor prognosis in elderly patients with severe pneumonia.IL-33 combined with procalcitonin has significant clinical efficacy in predicting the incidence of poor prognosis in elderly patients with severe pneumonia.