重症肺炎患者血清可溶性细胞黏附因子的检测及意义

Serum Levels of Soluble Vascular Endothelial Cell Selectin in Patients with Severe Pneumonia

目的:探讨重症肺炎患者血清中可溶性血管内皮细胞选择素(sES)、细胞间黏附分子-1(sICAM-1)和血管细胞间黏附分子-1(sVCAM-1)水平变化与预后的关系。方法:83例在重症监护病房治疗超过24 h的重症肺炎患者,按预后分为存活组(44例)和死亡组(39例),采用双抗夹心酶联免疫吸附法检测患者外周静脉血中sES、sICAM-1及sVCAM-1水平,应用Logistic二元回归分析筛选重症肺炎的独立危险因素,对各独立危险因素绘制受试者工作特征曲线(ROC)和计算曲线下面积,评价3种可溶性细胞黏附因子和APACHEⅡ评分对重症肺炎预后的评估价值。结果:死亡组的氧合指数(PaO 2/FiO 2)明显低于存活组,死亡组的APACHEⅡ评分、白细胞计数(WBC)、血清C反应蛋白(CRP)、血清降钙素原(PCT)均高于存活组,差异有统计学意义(P<0.01);死亡组的血清sES、sICAM、sVCAM均高于存活组,差异有统计学意义(P<0.01);sES、sICAM、APACHEⅡ评分是影响重症肺炎患者预后的独立危险因素,sES、sICAM和APACHEⅡ评分均对重症肺炎的预后有较高的预测价值,3个指标的联合应用可明显提高对重症肺炎患者死亡危险性的预测价值。结论:重症肺炎患者血清中sES和sICAM的表达与病情严重程度及预后密切相关,sES、sICAM联合APACHEⅡ评分可有效预测重症肺炎的预后。

Objective:To investigate the serum levels of soluble vascular endothelial cell selectin(sES),soluble intercellular adhesion molecule-1(sICAM-1)and vascular cell adhesion molecule-1(sVCAM-1)in evaluating severity and outcome of severe pneumonia.Methods:From May 2017 to May 2018,83 patients with pneumonia treated in ICU of Guizhou People's Hospital for more than 24 hours were divided into the survival group(44 cases)and the death group(39 cases).The levels of sES,sICAM-1 and sVCAM-1 in peripheral venous blood were detected by double-antibody sandwich enzyme-linked immunosorbent assay.Logistic binary regression analysis was used to screen the independent risk factors.The area under the curve(AUC)of the receiver operator characteristic(ROC)graph were calculated for each independent risk factor.Oxygenation Index,APACHE II scores,WBC,CRP,PCT,sES,sICAM and sVCAM were also determined.Results:No significant difference was found in general data and vital signs between the two groups.The oxygenation index of the death group with severe pneumonia was significantly lower than that of the survival group(P<0.01).APACHE II scores,WBC,CRP,PCT,sES,sICAM and sVCAM in the death group were higher than those in the survival group(P<0.01).The values of sES,sICAM and APACHE II were independent risk factors affecting the outcome of severe pneumonia.The scores of sES,sICAM and APACHEE II had high predictive value for the mortality of severe pneumonia.The combined application of the three indicators significantly improved the predictive value for the mortality risk of severe pneumonia.Conclusion:The expression of sES and sICAM in serum of patients with severe pneumonia is closely related to the severity and prognosis of the disease.SES,sICAM combined with APACHE II scores can effectively predict the prognosis of severe pneumonia.