呼吸机相关性肺炎患者血清降钙素原、载脂蛋白E和烟酰胺磷酸核糖转移酶表达及其预后相关影响因素分析

Expression of Serum Procalcitonin, Apolipoprotein E and Nicotinamide Phosphoribosyl Transferase in Patients with Ventilator-associated Pneumonia and the Related Factors Affecting Its Prognosis

目的探讨呼吸机相关性肺炎(ventilator-associated pneumonia, VAP)患者血清降钙素原(procalcitonin, PCT)、载脂蛋白E(apolipoprotein E, ApoE)和烟酰胺磷酸核糖转移酶(nicotinamide phosphoribosyl transferase, NAMPT)表达及其预后相关影响因素。方法选取曾使用呼吸机治疗116例,根据是否发生VAP将其分为VAP组(84例)和非VAP组(32例)两组。观察比较两组入院后1、3、7 d血清PCT、ApoE及NAMPT表达水平。收集VAP患者临床资料,采用Logistic回归分析对VAP患者预后相关影响因素进行分析。结果入院后1、3、7 d,VAP组组内血清PCT、ApoE及NAMPT表达水平总体比较差异有统计学意义(P<0.05);随着时间延长VAP组血清PCT、ApoE及NAMPT表达水平均逐渐升高,组内不同时间两两比较差异均有统计学意义(P<0.05)。入院后1、3、7 d,VAP组血清PCT、ApoE及NAMPT水平均高于非VAP组,差异有统计学意义(P<0.05)。84例VAP中,存活59例,死亡25例。非条件单因素分析结果显示,年龄、是否伴糖尿病、体质量指数(BMI)、PCT表达水平、ApoE表达水平、NAMPT表达水平及机械通气时间、是否使用抗生素、是否气管切开是影响VAP患者预后的因素。非条件多因素Logistic回归分析结果显示,BMI<18.5 mg/m^2、PCT≥5 ng/ml、ApoE≥60 mg/L、NAMPT≥3.0 ng/ml、机械通气时间≥72 h、未使用抗生素及有气管切开是影响VAP患者预后的独立危险因素。结论 VAP患者血清PCT、ApoE及NAMPT呈高水平表达,且血清PCT、ApoE及NAMPT高水平表达可增加VAP患者病死率。BMI<18.5 mg/m^2、PCT≥5 ng/ml、ApoE≥60 mg/L、NAMPT≥3.0 ng/ml、机械通气时间≥72 h、未使用抗生素及有气管切开是影响VAP患者预后独立危险因素。

Objective To analyze the expression of serum procalcitonin(PCT), apolipoprotein E(ApoE) and nicotinamide phosphoribosyl transferase(NAMPT) in patients with ventilator-associated pneumonia(VAP) and the related factors affecting its prognosis. Methods A total of 116 patients who had been treated with ventilator were selected. According to presence or absence of VAP, they were divided into VA P group(n=84) and non-VAP group(n=32). The expression levels of serum PCT, and ApoE at 1, 3, and 7 d after admission and the positive rate of NAMPT expression at admission between the two groups were observed. The clinical data of patients with VAP were collected, and the relevant factors affecting the prognosis of VAP were analyzed by logistic regression analysis. Results The difference in the levels of serum PCT and ApoE in the VAP group was statistically significant at 1, 3, and 7 d after admission(P<0.05). With the prolongation of time, the serum PCT and ApoE levels in the VAP group were gradually increased, and the differences in pairwise comparison at different time points in the group were statistically significant(P<0.05). The serum PCT and ApoE levels in the VAP group at 1, 3, and 7 d after admission were higher than those in the non-VAP group. At the time of admission, the positive expression rate of NAMPT in the VAP group was significantly higher than that in the non-VAP group, and the differences were statistically significant(P<0.05). In 84 cases with VAP, 59 cases survived, and 25 cases died. Univariate unconditional logistic regression analysis showed that age, presence or absence of diabetes mellitus, body mass index(BMI), PCT, ApoE, NAMPT expression and duration of mechanical ventilation, use of antibiotics, treatment with tracheotomy were factor influencing the prognosis of patients with VAP(P<0.05). The multivariate unconditional logistic regression analysis showed that BMI<18.5, PCT>5 ng/ml, ApoE>60 mg/L, NAMPT≥3.0 ng/ml, duration of mechanical ventilation>72 h, no use of antibiotics, and tracheotomy were independent risk factors affecting the prognosis of VAP patients(P<0.05). Conclusion PCT, ApoE and NAMPT are highly or strongly positively expressed in VAP patients, and the increased level of PCT and ApoE and positive expression of NAMPT can increase the mortality of VAP patients. BMI<18.5, PCT>5 ng/ml, ApoE>60 mg/L, NAMPT≥3.0 ng/ml, duration of mechanical ventilation >72 h, no use of antibiotics, and tracheotomy were independent risk factors affecting prognosis of VAP patients.