重症肺炎患者血清Presepsin,ICAM-1动态变化及其与预后的相关性研究

Dynamic Changes of Serum Presepsin and ICAM-1 in Patients with Severe Pneumonia and Their Relationship with Prognosis

目的探讨血清可溶性白细胞分化抗原14亚型(又称Presepsin)、细胞间黏附分子-1(ICAM-1)在重症肺炎中的动态变化及其与患者预后的关系。方法选取辽健集团阜新矿总医院在2019年8月~2020年8月期间收治的重症肺炎患者89例,根据患者治疗10天后的临床归转情况分为预后良好组(n=54)以及预后不良组(n=35)。检测并对比两组患者入院时、入院3天和入院5天的血清Presepsin,ICAM-1和降钙素原(PCT)水平以及急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)。分析重症肺炎患者血清Presepsin,ICAM-1与PCT及APACHE Ⅱ评分的相关性。接受者工作特征曲线(ROC)分析各个指标对重症肺炎患者预后情况的评估价值。结果各个时间点预后不良组的血清Presepsin,ICAM-1,PCT水平以及APACHE Ⅱ评分均高于预后良好组,差异均有统计学意义(t=2.078~8.331,均P<0.05);预后良好组的血清Presepsin,ICAM-1水平呈下降趋势,各个时间点比较差异有统计学意义(t=3.628~7.661,均P<0.05);预后不良组的血清Presepsin,ICAM-1水平呈上升趋势,但各个时间点比较差异无统计学意义(t=1.184~1.714,均P>0.05)。各个时间点重症肺炎患者血清Presepsin与ICAM-1,PCT及APACHE Ⅱ评分均呈正相关(r=0.311~0.442,均P<0.05),ICAM-1与PCT及APACHE Ⅱ评分均呈正相关(r=0.302~0.374,均P<0.05)。入院5天Presepsin和ICAM-1对重症肺炎患者预后情况的评估价值较高,曲线下面积分别为0.880(95%CI:0.802~0.957),0.843(95%CI:0.745~0.942)。结论重症肺炎患者血清Presepsin,ICAM-1持续处于较高水平与患者预后不良相关。检测二者水平可辅助临床评估患者预后。

Objective To investigate the dynamic changes of serum soluble leukocyte differentiation antigen 14(Presepsin) and intercellular adhesion molecule-1(ICAM-1) in patients with severe pneumonia and their relationship with prognosis. Methods 89 patients with severe pneumonia who were treated in Fuxin General Hospital of Liaojian Group from August 2019 to August 2020 were selected, and they were divided into good prognosis group(n=54) and poor prognosis group(n=35) according to the clinical outcome after 10 days of treatment. The levels of serum presepsin, ICAM-1, procalcitonin(PCT) and acute physiology and chronic health score Ⅱ(APACHE Ⅱ) were detected and compared between the two groups at admission, 3 days and 5 days after admission. The correlation of serum presepsin, ICAM-1 with PCT and APACHE Ⅱ score in patients with severe pneumonia were analyzed. Receiver operating characteristic curve(ROC) was used to analyze the prognostic value of each index in patients with severe pneumonia. Results At each time point, the levels of serum presepsin, ICAM-1, PCT and APACHE Ⅱ score in the poor prognosis group were significantly higher than those in the good prognosis group,the differences were statistically signifcant(t=2.078~8.331,all P<0.05). The levels of serum presepsin, ICAM-1 and PCT in the good prognosis group showed a downward trend, and the difference was statistically significant at each time point(t=3.628~7.661, all P<0.05). The levels of serum presepsin, ICAM-1 and PCT in the poor prognosis group showed an upward trend, but the difference was not statistically significant at each time point(t=1.184~1.714, all P>0.05). At each time point, serum presepsin was positively correlated with ICAM-1, PCT and APACHE Ⅱ scores(r=0.311~0.442, all P<0.05), and ICAM-1 was positively correlated with PCT and APACHE Ⅱ scores(r=0.302~0.374,all P<0.05). Presepsin and ICAM-1 on the 5 days after admission had higher value in evaluating the prognosis of patients with severe pneumonia, and the area under the curve was 0.880(95%CI:0.802~0.957) and 0.843(95%CI:0.745~0.942), respectively.Conclusion Persistent high levels of serum presepsin and ICAM-1 in patients with severe pneumonia are associated with poor prognosis. Detection of the levels of presepsin and ICAM-1 can help to evaluate the prognosis of patients.