重症肺部感染合并呼吸衰竭患者外周血生物标志物水平与预后的关系

Peripheral blood biomarkers in patients with severe pulmonary infection combined with respiratory failure and their association with prognosis

目的 针对重症肺部感染合并呼吸衰竭,筛选出准确可靠的外周血生物标志物,分析其对预后的预测评估价值。方法 选取2019年1月-2020年12月医院收治的重症肺部感染合并呼吸衰竭患者117例,并根据28 d预后情况分为生存组84例和死亡组33例。分析转入重症监护室(ICU)后静脉血检测相关指标结果。结果 死亡组患者白细胞介素-6(IL-6)、降钙素原(PCT)、红细胞沉降率(ESR)、淀粉样蛋白A(SAA)、D-二聚体(D-D)、血肌酐(Cr)、血尿素氮(BUN)、B型利钠肽(NT-proBNP)、巨噬细胞炎症蛋白-2(MIP-2)、高迁移率族蛋白B1(HMGB1)、中枢神经特异性蛋白(S100-β)、髓过氧化物酶(MPO)水平均高于生存组(P<0.05);Logistic回归分析显示IL-6、PCT、D-D、BUN、NT-proBNP、HMGB1、S100-β是评估预后的影响因素;受试者工作特征曲线(ROC)分析显示上述指标评估预后的曲线下面积分别为0.706、0.722、0.728、0.784、0.682、0.707、0.741。BUN的灵敏度最高,为84.52%,HMGB1特异度最高,为78.79%。结论 针对重症肺部感染合并呼吸衰竭的预后评估,筛选出7个有价值的外周血生物标志物,分别为IL-6、PCT、D-D、BUN、NT-proBNP、HMGB1和S100-β。

OBJECTIVE To screen out accurate and reliable peripheral blood biomarkers for severe pulmonary infection with respiratory failure, and analyze their prognostic value. METHODS A total of 117 patients with severe pulmonary infection and respiratory failure admitted to the hospital from Jan. 2019 to Dec. 2020 were selected and divided into 84 cases of survival group and 33 cases of death group according to the 28-day prognosis. The results of the related indicators of venous blood was analyzed after transfer to intensive care unit(ICU). RESULTS The levels of IL-6, PCT, ESR, SAA, D-D, Cr, BUN, NT-proBNP, MIP-2, MPO, HMGB1 and S100-β in the death group were significantly higher than those in the survival group(P<0.05). Logistic regression analysis showed that IL-6, PCT, D-D, BUN, NT-proBNP, HMGB1 and S100-β were influencing factors in evaluating prognosis. Receiver operating characteristic curve(ROC) analysis showed that the area under curve for the above indicators to evaluate prognosis was 0.706, 0.722, 0.728, 0.784, 0.682, 0.707, and 0.741, respectively. BUN had the highest sensitivity, which was 84.52%, and HMGB with the highest specificity, which was 78.79%. CONCLUSION Totally 7 valuable peripheral blood biomarkers were screened for the prognosis of severe pulmonary infection combined with respiratory failure, namely IL-6, PCT, D-D, BUN, NT-proBNP, HMGB1, and S100-β.