老年重症肺炎患者血清4-HNE、APC、sCD163预测预后不良的价值

Value of serum 4-hydroxynonenal,activated protein C,and soluble hemoglobin scavenger receptor 163 in predicting poor prognosis in elderly patients with severe pneumonia

目的探讨老年重症肺炎(SP)患者血清4-羟基壬烯醛(4-HNE)、活化蛋白C(APC)、可溶性血红蛋白清道夫受体163(sCD163)对预后不良的预测价值。方法选取2020年8月至2022年8月新乡医学院第一附属医院收治的200例老年SP患者纳入SP组,另选取同期、同年龄段200例老年普通肺炎患者纳入普通肺炎组。比较两组患者和SP组不同预后患者的血清4-HNE、APC、sCD163水平,并采用Pearson法分析SP组患者血清4-HNE、APC、sCD163水平与肺部感染评分(CPIS评分)的相关性,采用Logistic回归分析老年SP患者死亡的影响因素,采用受试者工作特性曲线(ROC)分析各指标对预后情况的预测效能。结果SP组患者的血清4-HNE、sCD163水平分别为(21.27±4.02)mg/L、(154.27±56.34)pg/mL,明显高于普通肺炎组的(15.63±3.49)mg/L、(112.17±37.59)pg/mL,APC水平为(25.47±5.06)pmol/L,明显低于普通肺炎组的(30.12±6.14)pmol/L,差异均具有统计学意义(P<0.05);经Pearson法分析结果显示,入院时SP患者的血清4-HNE、sCD163水平与CPIS评分呈正相关(r=0.754、0.723,P<0.05),APC水平与之呈负相关(r=-0.695,P<0.05);入院3 d、7 d后,死亡组患者的血清4-HNE分别为(23.89±6.12)mg/L、(26.01±8.27)mg/L,明显高于生存组的(19.03±4.11)mg/L、(17.25±3.56)mg/L,sCD163水平分别为(182.34±60.33)pg/mL、(219.46±70.41)pg/mL,明显高于生存组的(137.83±30.24)pg/mL、(120.74±25.17)pg/mL,APC水平分别为(23.04±4.89)pmol/L、(20.73±4.25)pmol/L,明显低于生存组的(27.42±4.09)pmol/L、(29.76±4.14)pmol/L,差异均具有统计学意义(P<0.05);Logistic回归分析结果显示,入院3 d、7 d后,血清4-HNE(>20.32 mg/L、>19.57 mg/L)、sCD163(>149.63 pg/mL、>146.90 pg/mL)是老年SP患者治疗28 d后死亡的危险因素,APC(>26.26 pmol/L、>27.37 pmol/L)是其保护因素(P<0.05);ROC分析结果显示,入院3 d后血清各指标水平联合预测死亡的曲线下面积(AUC)为0.910(95%CI:0.861~0.946),最佳预测敏感度、特异度分别为81.13%、86.39%,入院7 d后联合预测死亡的AUC为0.922(95%CI:0.876~0.955),最佳敏感度、特异度分别为90.57%、84.35%。结论血清4-HNE、APC、sCD163水平与老年SP发生、发展相关,各指标水平与CPIS评分均具有一定相关性,联合检测对老年SP患者预后情况具有一定预测价值,可作为临床评估肺部感染程度及预后的辅助指标。

Objective To investigate the prognostic value of serum 4-hydroxynonenal(4-HNE),activated protein C(APC),and soluble hemoglobin scavenger receptor 163(sCD163)in elderly patients with severe pneumonia(SP).Methods A total of 200 elderly patients with SP admitted to the First Affiliated Hospital of Xinxiang Medical College from August 2020 to August 2022 were selected for the SP group.Another 200 elderly patients with common pneumonia in the same age group were selected for the common pneumonia group.The serum levels of 4-HNE,APC,and sCD163 were compared between the two groups and between patients with different prognosis in the SP group.The Pearson method was used to analyze the correlation between the serum levels of 4-HNE,APC,sCD163 and the clinical pulmonary infection score(CPIS score)in the SP group.Logistic regression analysis was used to analyze the influencing factors of death in elderly patients with SP.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of each indicator on prognosis.Results The levels of serum 4-HNE and sCD163 in SP group were(21.27±4.02)mg/L and(154.27±56.34)pg/mL,respectively,which were significantly higher than(15.63±3.49)mg/L and(112.17±37.59)pg/mL in the common pneumonia group,and the level of APC was(25.47±5.06)pmol/L,significantly lower than(30.12±6.14)pmol/L in the common pneumonia group(P<0.05).The Pearson analysis showed that the levels of serum 4-HNE and sCD163 in patients with SP at admission were positively correlated with the CPIS score(r=0.754,0.723,P<0.05),while the level of APC was negatively correlated with the CPIS score(r=-0.695,P<0.05).After 3 days and 7 days of admission,the serum 4-HNE levels in the death group were(23.89±6.12)mg/L and(26.01±8.27)mg/L,respectively,which were significantly higher than(19.03±4.11)mg/L and(17.25±3.56)mg/L in the survival group;the levels of sCD163 were(182.34±60.33)pg/mL and(219.46±70.41)pg/mL,respectively,significantly higher than(137.83±30.24)pg/mL and(120.74±25.17)pg/mL in the survival group;the levels of APC were(23.04±4.89)pmol/L and(20.73±4.25)pmol/L,respectively,significantly lower than(27.42±4.09)pmol/L and(29.76±4.14)pmol/L in the survival group;the differences were statistically significant(P<0.05).The results of logistic regression analysis showed that serum 4-HNE(>20.32 mg/L,>19.57 mg/L)and sCD163(>149.63 pg/mL,>146.90 pg/mL)were risk factors for death in elderly SP patients after 28 days of treatment,while APC(>26.26 pmol/L,>27.37 pmol/L)was a protective factor(P<0.05).The results of ROC analysis showed that the area under the curve(AUC)of the combined detection of the three indexes for predicting death after 3 days of admission was 0.910(95%CI:0.861-0.946),with the best sensitivity and specificity of 81.13%and 86.39%,respectively.The AUC of combined detection of the three indexes death for predicting after 7 days of admission was 0.922(95%CI:0.876-0.955),with the best sensitivity and specificity of 90.57%and 84.35%,respectively.Conclusion Serum levels of 4-HNE,APC,and sCD163 are correlated with the occurrence and development of SP in elderly patients,and each index level has a certain correlation with CPIS score.Combined detection has a certain predictive value for the prognosis of elderly patients with SP,and can be used as an auxiliary index for clinical evaluation of the degree of pulmonary infection and prognosis.