重症肺炎患者灌洗液中sTREM-1、IL-4水平与疗效的关系

Relationship between levels of sTREM-1 and IL-4 in lavage fluid and curative effect in patients with severe pneumonia

目的分析重症肺炎患者灌洗液中可溶性髓样细胞触发受体-1(sTREM-1)、白细胞介素-4(IL-4)水平与疗效的关系。方法采用回顾性分析的方法选取2018年1月至2021年12月在郑州大学附属洛阳中心医院经常规治疗联合肺泡灌洗治疗无效的40例重症肺炎患者纳入无效组;将同期经常规治疗联合肺泡灌洗治疗有效的40例重症肺炎患者纳入有效组。比较两组患者的基线资料及实验室指标,比较两组治疗前sTREM-1、IL-4水平,并分析重症肺炎患者治疗前灌洗液中sTREM-1、IL-4水平与疗效的关系。结果无效组治疗前血清C-反应蛋白(CRP)及灌洗液中sTREM-1、IL-4水平高于有效组,差异有统计学意义(P<0.05);组间其他资料比较差异未见统计学意义(P>0.05)。经Logistic回归分析结果显示,治疗前血清CRP及灌洗液中sTREM-1、IL-4异常表达与重症肺炎患者经纤支镜下肺泡灌洗治疗无效有关,血清CRP及sTREM-1、IL-4高表达是重症肺炎患者治疗无效的危险因素(OR>1,P<0.05);绘制ROC曲线,结果显示,治疗前灌洗液中sTREM-1、IL-4水平单独及联合检测预测重症肺炎患者疗效的曲线下面积(AUC)>0.80,均具有一定预测价值,且以联合检测价值最高,且当各指标cut-off值分别取167.750 ng/L、8.995 g/L时,可获得最佳预测价值。结论重症肺炎患者灌洗液中sTREM-1、IL-4水平与疗效有关。

Objective To analyze the relationship between the levels of soluble myeloid cell trigger receptor-1(sTREM-1)and interleukin-4(IL-4)in the lavage fluid and the curative effect in patients with severe pneumonia.Methods Retrospective analysis was used to select 40 patients with severe pneumonia who were ineffective in routine treatment combined with alveolar lavage in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2018 to December 2021,and they were included in the ineffective group.Forty patients with severe pneumonia who were effectively treated by routine therapy combined with alveolar lavage were included in the effective group.The baseline data and laboratory indexes of the two groups were compared.The levels of sTREM-1 and IL-4 in the two groups before treatment were compared.The relationship between the levels of sTREM-1 and IL-4 in the lavage fluid of patients with severe pneumonia before treatment and the efficacy was analyzed.Results The levels of serum C-reactive protein(CRP),sTREM-1 and IL-4 in lavage fluid in the ineffective group were significantly higher than those in the effective group before treatment(P<0.05).There was no significant difference in other data between the two groups(P>0.05).The results of logistic regression analysis showed that the abnormal expression of serum CRP,sTREM-1 and IL-4 in lavage fluid before treatment was correlated with the ineffectiveness of alveolar lavage under fibrobronchoscope in patients with severe pneumonia.The high expression of serum CRP,sTREM-1 and IL-4 in lavage fluid was a risk factor for the ineffectiveness of treatment in patients with severe pneumonia(OR>1,P<0.05).The ROC curve was drawn,and the results showed that the area under the curve(AUC)of sTREM-1 and IL-4 levels in the lavage fluid before treatment for predicting the efficacy of patients with severe pneumonia was>0.80,and the value of combined detection was the highest.When the cut-off value of each index was 167.750 ng/L and 8.995 g/L respectively,the best predictive value could be obtained.Conclusions The levels of sTREM-1 and IL-4 in lavage fluid of patients with severe pneumonia are correlated with the curative effect.