重症肺炎患者血清APC、IL-18的表达及其与临床预后的相关性

Expression of serum APC and IL-18 in patients with severe pneumonia and its correlation with clinical prognosis

目的探讨血清活化蛋白C(APC)、白介素(IL)-18与重症肺炎患者临床预后的关系。方法选取武警北京总队医院2018年1月-2021年1月收治的80例重症肺炎患者为观察组,并同期选取医院收治的80例非重症肺炎患者为对照组。记录重症肺炎患者28d内生存情况。调查患者基线资料和检测血清APC、IL-18等实验室指标,分析血清APC、IL-18与患者临床预后的相关性。结果观察组血清APC水平低于对照组,IL-18水平高于对照组,差异有统计学意义(P<0.05);80例重症肺炎患者的病死率为31.25%;病死组的机械通气占比高于存活组,CPIS、IL-18、PCT水平均高于存活组,APC水平低于存活组,差异有统计学意义(P<0.05);经COX回归分析结果显示,机械通气、CPIS、血清IL-18、APC和PCT水平与重症肺炎患者临床预后有关(P<0.05);绘制受试者工作特征曲线(ROC)和限制性立方样条分析显示,血清IL-18、APC联合预测重症肺炎患者临床预后的价值最好,且二者与重症肺炎患者临床预后呈线性剂量反应关系(P<0.05)。结论重症肺炎患者血清APC、IL-18与临床预后存在相关性。

Objective To investigate the relationship of serum activated protein C(APC)and interleukin(IL)-18 with clinical prognosis in patients with severe pneumonia.Methods 80 patients with severe pneumonia treated in Beijing Armed Police Corps Hospital from January 2018 to January 2021 were selected as the observation group,and 80 patients with non severe pneumonia treated in the hospital were selected as the control group during the same period.The survival of patients with severe pneumonia within 28 days was recorded.The baseline data of patients were investigated and the laboratory indicators such as serum APC and IL-18 were detected.The correlation of serum APC and IL-18 with the clinical prognosis of patients was analyzed.Results Compared with the control group,the level of serum APC in the observation group was lower,and the level of IL-18 was higher(P<0.05).Among the 80 patients with severe pneumonia,the case fatality rate was 31.25%.Compared with the survival group,the proportion of mechanical ventilation in the death group was higher,and the CPIS,IL-18 and PCT levels were higher,and the APC level was lower(P<0.05).The results of COX regression analysis showed that,mechanical ventilation,CPIS,serum IL-18,APC and PCT levels were related to the clinical prognosis of patients with severe pneumonia(P<0.05).The receiver operating characteristic curve(ROC)and restricted cubic spline analysis showed that the combination of serum IL-18 and APC had the best value in predicting the clinical prognosis of patients with severe pneumonia,and they had a linear dose-response relationship with the clinical prognosis of patients with severe pneumonia(P<0.05).Conclusion There is a correlation of serum APC and IL-18 with clinical prognosis in patients with severe pneumonia.