呼吸机相关性肺炎预后预测方法

Prediction of prognosis of patients with ventilator-associated pneumonia

目的探究血清中性粒细胞弹性蛋白酶(NE)、可溶性尿激酶型纤溶酶原激活物受体(su-PAR)、白细胞介素-35(IL-35)对机械通气合并呼吸机相关性肺炎(VAP)患者临床预后的预测。方法选取河南省人民医院2017年1月-2019年8月收治的机械通气合并VAP患者114例作为研究对象,随访30 d,根据预后情况分为生存组80例、死亡组34例。比较两组确诊VAP时、治疗1 d、3 d、5 d、7 d时血清NE、su-PAR、IL-35水平,采用Logistic回归分析血清各指标与预后的关系,采用受试者工作特征(ROC)曲线及ROC曲线下面积(AUC)分析血清NE、su-PAR、IL-35对预后的预测价值,采用卡普兰-迈耶曲线(K-M)分析血清NE、su-PAR、IL-35高危者、低危者的生存曲线。结果死亡组确诊VAP时血清NE、su-PAR、IL-35分别为(177.20±36.52)μg/L、(9.82±1.39)ng/ml、(35.10±4.03)pg/ml,高于生存组的(142.29±30.04)μg/L、(7.46±1.15)ng/ml、(31.27±3.47)pg/ml(P<0.001);血清NE、su-PAR、IL-35与预后显著相关(P<0.05);死亡组血清NE、su-PAR、IL-35治疗1 d、3 d、5 d、7 d呈升高趋势,生存组血清NE、su-PAR、IL-35水平在治疗5 d时达到高峰,治疗7 d时显著下降,且生存组治疗1 d、3 d、5 d、7 d血清NE、su-PAR、IL-35水平低于死亡组(P<0.05);预测预后的AUC:NE为0.741,su-PAR为0.720,IL-35为0.804,三者联合为0.873,联合检测优于单独检测(P<0.05);血清NE、su-PAR、IL-35高危者死亡率高于低危者(P<0.05)。结论血清NE、su-PAR、IL-35在机械通气合并VAP病死患者中呈高表达,与预后显著相关,并具有较高的预后预测价值。

OBJECTIVE To investigate the effects of serum neutrophil elastase(NE), soluble urokinase-plasminogen activator receptor(su-PAR), and interleukin-35(IL-35) expression on the clinical prognosis of patients with mechanical ventilation combined with ventilator-associated pneumonia(VAP). METHODS A total of 114 patients with mechanical ventilation combined with VAP who were admitted to the Henan Provincial People′s Hospital from Jan. 2017 to Aug. 2019 were selected as the research subjects. They were followed up for 30 days and divided into 80 cases of survival group and 34 cases of death group according to the prognosis. The serum NE, su-PAR, and IL-35 levels at the time of diagnosis of VAP and 1 d, 3 d, 5 d, and 7 d treatment were compared between the two groups. Logistic regression was used to analyze the relationship between serum indexes and prognosis, and receiver operating characteristic(ROC) curve and area under ROC(AUC) were used to analyze the predictive value of serum NE, su-PAR, and IL-35 on prognosis, the Kaplan-Meier curve(K-M) was used to analyze the survival curves of serum NE, su-PAR, and IL-35 in high-risk and low-risk patients. RESULTS Serum NE, su-PAR and IL-35 at the time of diagnosis of VAP in the death group were(177.20±36.52) μg/L,(9.82±1.39) ng/ml,(35.10±4.03) pg/ml, respectively, which were significantly higher than those in the survival group(142.29±30.04)μg/L,(7.46±1.15)ng/ml,(31.27±3.47) pg/ml(P<0.05);serum NE, su-PAR, and IL-35 were significantly correlated with prognosis(P<0.05);the levels of serum NE, su-PAR, and IL-35 in the death group showed an increasing trend at 1 day, 3 days, 5 days, and 7 days after treatment, the levels of serum NE, su-PAR, and IL-35 in the survival group reached a peak at 5 days of treatment and significantly decreased at 7 days of treatment;and the serum NE, su-PAR, and IL-35 levels in the survival group were significantly lower than those in the death group at 1 day, 3 days, 5 days, and 7 days of treatment(P<0.05);AUC for predicting prognosis: NE was 0.741, su-PAR was 0.720, IL-35 was 0.804, and the combination of the three was 0.873(P<0.05), the combined detection was significantly better than single detection(P<0.05);the mortality of high-risk patients with serum NE, su-PAR, and IL-35 was significantly higher than that of low-risk patients(P<0.05). CONCLUSION Serum NE, su-PAR, and IL-35 were highly expressed in patients with mechanical ventilation combined with VAP deaths, which were significantly correlated with prognosis and had high prognostic value.