血清SOD和乳酸与胆碱酯酶在重症肺部感染患者中的表达及预测价值

Expression of serum SOD,lactate and cholinesterase in patients with severe pulmonary infection and predictive value

目的探究血清超氧化物歧化酶(SOD)、乳酸(Lac)、胆碱酯酶(sCHE)在重症肺部感染患者中的表达意义及预测机械通气撤机结局的价值。方法选取南阳市第一人民医院2017年5月-2019年5月收治的重症肺部感染患者55例(重症组)、非重症肺部感染患者50例(非重症组)。对比两组血清SOD、Lac、sCHE水平、急性生理与慢性健康状况评价系统Ⅱ(APACHEⅡ)、临床肺部感染评分(CPIS)。重症组均给予机械通气治疗,根据撤机结局分为撤机成功患者、撤机失败患者,比较不同撤机结局患者血清SOD、Lac、sCHE水平,受试者工作特征(ROC)曲线分析各指标对撤机结局的预测价值。结果重症组血清Lac水平高于非重症组,SOD、sCHE低于非重症组(P<0.05);重症组APACHEⅡ、CPIS高于非重症组(P<0.05);Pearson相关性分析,血清Lac(r1=0.553,r2=0.718)与APACHEⅡ、CPIS评分呈正相关,SOD(r1=-0.476,r2=-0.402)、sCHE(r1=-0.537,r2=-0.576)与APACHEⅡ、CPIS评分呈负相关(P<0.05);撤机前,撤机成功患者血清Lac水平低于撤机失败患者,SOD、sCHE水平高于撤机失败者(P<0.05);ROC曲线分析显示,三者联合预测撤机结局AUC(0.923)>Lac(0.806)>sCHE(0.768)>SOD(0.745),敏感度为92.31%,特异度为85.71%。结论血清SOD、Lac、sCHE与重症肺部感染患者病情及感染程度密切相关,可作为预测机械通气撤机结局的重要因子。

OBJECTIVE To explore the significance of expression of serum superoxide dismutase(SOD),lactate(Lac)and cholinesterase(sCHE)in patients with severe pulmonary infection and analyze the value in prediction of outcomes due to withdrawal of mechanical ventilation.METHODS Totally 55 patients with severe pulmonary infection who were treated in Nanyang First People’s Hospital from May 2017 to May 2019 were chosen as the severe group,and 50 patients without severe pulmonary infection were set as the non-severe group.The levels of serum SOD,Lac,sCHE,acute physiology and chronic health evaluation II(APACHE II)and clinical pulmonary infection score(CPIS)were compared between the two groups.The patients of the severe group were given mechanical ventilation and were divided into the patients who succeeded in withdrawal of ventilation and the patients who failed to the withdrawal of ventilation according to the outcomes.The levels of serum SOD,Lac and sCHE were compared among the patients with different outcomes,and receiver operating characteristic(ROC)curve analysis was performed for the value of the serum indexes in prediction of the outcomes.RESULTS The serum Lac level of the severe group was significantly higher than that of the non-severe group,and the levels of SOD and sCHE of the severe group were significantly lower than those of the non-severe group(P<0.05).The APACHEⅡand CPIS were significantly higher in the severe group than in the non-severe group(P<0.05).Pearson correlation analysis showed that the serum Lac(r1=0.553,r2=0.718)was positively correlated with APACHEⅡand CPIS scores,and SOD(r1=-0.476,r2=-0.402)and sCHE(r1=-0.537,r2=-0.576)were negatively correlated with APACHEⅡand CPIS scores(P<0.05).Before withdrawal of ventilation,the serum Lac level of the patients who succeeded in the withdrawal of ventilation was significantly lower than that of the patients who failed to,while the levels of SOD and sCHE of the patients who succeeded were significantly higher than those of the patients who failed(P<0.05).ROC curve analysis indicated that the AUC of the joint detection of the three indexes was 0.923 in prediction of the outcomes,greater than 0.806 of Lact,0.768 of sCHE 0.768,and 0.745 of SOD;the sensitivity was 92.31%,and the specificity was 85.71%.CONCLUSION The serum SOD,Lac,and sCHE are closely related to the illness condition of the patients with severe pulmonary infection and the severity of infection,which can be used as important factors for prediction of outcomes.