血浆sRAGE、Nampt水平与呼吸机相关性肺炎患者病情程度和预后的关系

Relationships between plasma sRAGE,Nampt levels and severity and prognosis of patients with ventilator-associated pneumonia

目的探讨血浆可溶性晚期糖基化终末产物受体(sRAGE)、烟酰胺磷酸核糖转移酶(Nampt)水平与呼吸机相关性肺炎(VAP)患者病情程度和预后的关系。方法选择VAP患者143例(观察组),根据病情程度分为重度38例、中度49例、轻度56例,随访28 d,期间死亡41例、存活102例。同期选择体检健康的志愿者50例(对照组)。采集所有研究对象肘静脉血,离心留取血浆,检测血浆sRAGE、Nampt。比较观察组与对照组以及不同病情程度VAP患者血浆sRAGE、Nampt水平,分析VAP患者血浆sRAGE、Nampt水平与急性生理学与慢性健康状况评估Ⅱ(APACHEⅡ)评分的关系。收集VAP患者临床资料,分析其预后不良的影响因素。采用受试者工作特征(ROC)曲线评估血浆sRAGE、Nampt水平对VAP患者预后不良的预测价值。结果观察组血浆sRAGE、Nampt水平均显著高于对照组(P均<0.01);随着VAP病情加重,血浆sRAGE、Nampt水平逐渐升高(P均<0.01)。VAP患者血浆sRAGE、Nampt水平与APACHEⅡ评分均呈正相关关系(P均<0.01)。多因素Logistic回归分析显示,年龄≥60岁、机械通气时间≥72 h、糖尿病史、气管切开、病灶累及肺叶≥2个、APACHEⅡ评分、sRAGE、Nampt为VAP患者预后不良的独立危险因素,而平均动脉压≥65 mmHg则为其独立保护因素(P均<0.05)。血浆sRAGE、Nampt水平联合预测VAP患者预后不良的ROC曲线下面积显著高于血浆sRAGE、Nampt水平单独(P均<0.05)。结论VAP患者血浆sRAGE、Nampt水平显著升高,其水平变化与病情程度和预后密切相关;血浆sRAGE、Nampt水平升高是VAP患者预后不良的独立危险因素,并可作为预测VAP患者预后不良的生物标志物。

Objective To investigate the relationships between the levels of plasma soluble receptor for advanced glycation end products(sRAGE)and nicotinamide phosphoribosyltransferase(Nampt)and the severity and prognosis of patients with ventilator-associated pneumonia(VAP).Methods Totally 143 VAP patients(observation group)were selected.According to the degree of disease,they were divided into 38 severe cases,49 moderate cases,and 56 mild cases.During the follow-up period of 28 days,41 cases died and 102 cases survived.During the same period,50 healthy volunteers(control group)were selected.The elbow vein blood was collected,and the plasma was centrifuged to determine the plasma sRAGE and Nampt.The plasma sRAGE and Nampt levels in the observation group,the control group and VAP patients with different conditions were compared,and the relationships between the plasma sRAGE and Nampt levels in the VAP patients and the acute physiology and chronic health assessmentⅡ(APACHEⅡ)score were analyzed.The clinical data of VAP patients were collected,and the influencing factors of poor prognosis were analyzed.Plasma sRAGE and Nampt levels in all subjects were determined by ELISA.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of plasma sRAGE and Nampt levels for poor prognosis in VAP patients.Results The plasma levels of sRAGE and Nampt in the observation group were significantly higher than those in the control group(both P<0.01).With the aggravation of VAP,the levels of plasma sRAGE and Nampt gradually increased(both P<0.01).Plasma sRAGE and Nampt levels in VAP patients were positively correlated with APACHEⅡscore(both P<0.01).Multivariate Logistic regression analysis showed that age≥60 years,mechanical ventilation time≥72 h,history of diabetes,tracheotomy,≥2 lesions involving lobes,APACHEⅡscore,sRAGE,and Nampt were independent risk factors for poor prognosis in VAP patients,while mean arterial pressure≥65 mmHg was an independent protective factor(all P<0.05).The area under the ROC curve of plasma sRAGE combined with Nampt levels in predicting poor prognosis of VAP patients was significantly higher than that of plasma sRAGE and Nampt levels alone(both P<0.05).Conclusions Plasma sRAGE and Nampt levels significantly increase in VAP patients,and their elevated levels are closely related to disease severity and prognosis.Plasma sRAGE and Nampt levels are independent risk factors for poor prognosis in VAP patients,and can be used as biomarkers to predict poor prognosis in VAP patients.