重症医院获得性肺炎患者的细胞因子表达水平及临床意义

Cytokine Expression Levels and Clinical Significance in Patients with Severe Hospital-acquired Pneumonia

目的:探讨重症医院获得性肺炎(SHAP)患者的细胞因子表达水平及临床意义。方法:选取2018年1月-2020年12月钦州市第二人民医院呼吸与危重症医学科收治的SHAP患者45例为观察组(根据患者住院30 d内生存结局划分存活亚组28例、死亡亚组17例),选取同期普通肺炎患者45例为对照组。检测并比较对照组与观察组患者血清降钙素原(PCT)、D-二聚体(D-D)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)及可溶性细胞间黏附因子-1(sICAM-1)水平;比较存活亚组与死亡亚组患者PCT、D-D、TNF-α、IL-8、IL-10、sICAM-1水平。结果:观察组血清PCT、D-D、TNF-α、IL-8、IL-10、sICAM-1表达水平高于对照组,差异有统计学意义(P<0.001);第1、3、5、7天,存活亚组患者的血清PCT、D-D、TNF-α、IL-8、IL-10、sICAM-1表达水平随时间延长而降低,差异有统计学意义(P<0.05);存活亚组血清PCT、D-D、TNF-α、IL-8、IL-10、sICAM-1表达水平均低于死亡亚组,差异有统计学意义(P<0.05)。结论:SHAP患者血清PCT、D-D、TNF-α、IL-8、IL-10、sICAM-1均呈高表达状态,与病情转归密切相关,监测其变化规律,有助于临床上对SHAP病情及预后的研判。

Objective:To investigate the cytokine expression level and clinical significance of severe hospital-acquired pneumonia(SHAP).Methods:Forty-five patients with SHAP admitted to the Department of Respiratory and Critical Care Medicine of Qinzhou Second People's Hospital from January 2018 to December 2020 were selected as the observation group(according to the survival outcome within 30 days of hospitalization,the patients were divided into a survival subgroup of 28 cases and a death subgroup of 17 cases).Forty-five patients with common pneumonia during the same period were selected as control group.Serum levels of procalcitonin(PCT),D-dimer(D-D),tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),interleukin-10(IL-10)and soluble intercellular adhesion factor-1(sICAM-1)were detected and compared between control group and observation group.The levels of PCT,D-D,TNF-α,IL-8,IL-10 and sICAM-1 were compared between the surviving subgroup and the dying subgroup.Results:The expression levels of PCT,D-D,TNF-α,IL-8,IL-10 and sICAM-1 in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.001).At day 1,3,5 and 7,the expression levels of serum PCT,D-D,TNF-α,IL-8,IL-10 and sICAM-1 in survival subgroup were decreased with the extension of time,and the difference was statistically significant(P<0.05).The expression levels of serum PCT,D-D,TNF-α,IL-8,IL-10 and sICAM-1 in survival subgroup were lower than those in death subgroup,and the difference was statistically significant(P<0.05).Conclusion:Serum PCT,D-D,TNF-α,IL-8,IL-10 and sICAM-1 in patients with SHAP are highly expressed,which is closely related to the outcome of the disease,monitoring the change regularity,which is helpful for clinical research and prognosis of SHAP.