老年肺部感染患者血清HBP、IL-6、pro-ADM水平变化及鉴别病原菌类型的ROC分析

Changes in HBP,IL-6,and pro-ADM levels of lung infection in elderly and value evaluation on pathogen identification based on ROC analysis

目的探讨老年肺部感染患者血清肝素结合蛋白(HBP)、白介素-6(IL-6)、前肾上腺髓质素(pro-ADM)水平变化及鉴别病原菌类型的价值。方法选取2018年5月至2021年5月老年肺部感染患者126例为观察组,同期选取健康体检者46例作为对照组。比较2组血清HBP、IL-6、pro-ADM水平,分析老年肺部感染患者血清HBP、IL-6、pro-ADM水平与感染程度的相关性,比较不同病原菌感染患者血清HBP、IL-6、pro-ADM水平,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析血清HBP、IL-6、pro-ADM水平鉴别肺部感染病原菌类型的价值。结果观察组血清HBP、IL-6、pro-ADM水平高于对照组(P<0.05);不同感染程度患者血清HBP、IL-6、pro-ADM水平比较,差异有统计学意义(P<0.05),随感染程度增加,血清HBP、IL-6、pro-ADM水平逐渐升高(P<0.05);老年肺部感染患者血清HBP、IL-6、pro-ADM水平与感染程度呈正相关关系(P<0.05);G^(-)感染患者血清HBP、IL-6、pro-ADM水平高于G^(+)感染及真菌感染患者(P<0.05),G^(+)感染患者血清IL-6水平低于真菌感染患者(P<0.05);ROC曲线显示,鉴别G^(-)、真菌时,HBP、IL-6、pro-ADM联合鉴别的AUC值为0.965,大于单独指标鉴别;鉴别G^(+)、真菌时,IL-6鉴别的AUC值为0.748;鉴别G^(-)、G^(+)时,IL-6单独鉴别的AUC值为0.943,显著大于HBP、pro-ADM单独鉴别(P<0.05)。结论老年肺部感染患者血清HBP、IL-6、pro-ADM表达与感染程度呈正相关,且可用于不同病原菌鉴别,指导临床开展针对性治疗。

Objective To explore the changes in serum levels of heparin-binding protein(HBP),interleukin-6(IL-6)and pro-adrenomedullin(pro-ADM)in elderly patients with lung infection and evaluate its value on pathogen identification.Methods From May 2018 to May 2021,elderly patients with lung infection(n=126,observation group)and healthy patients(n=46,control group)in our hospital were included.The levels of serum HBP,IL-6,and pro-ADM were compared between the two groups,the correlation between serum HBP,IL-6,pro-ADM levels and the degree of infection was analyzed.The serum levels of HBP,IL-6,and pro-ADM in patients infected with different pathogenic bacteria were assessed.The receiver operating characteristic(ROC)curve and the area under the ROC(AUC)were used to analyze the value of serum HBP,IL-6,and pro-ADM levels for pathogen identification.Results The observation group had significantly higher HBP,IL-6 and pro-ADM than the control group(P<0.05);differences in patients with different infection degrees were significant(P<0.05).HBP,IL-6 and pro-ADM elevated gradually with increasing infection degree(P<0.05),a positive correlation was found in elderly patients between HBP,IL-6,pro-ADM and infection degree(P<0.05).Patients with Gram-negative(G^(-))infection had significantly higher HBP,IL-6 and pro-ADM than patients with Gram-positive(G^(+))infection(P<0.05),and patients with G^(+)infection had significantly lower IL-6 than patients with fungal infection(P<0.05);when identifying G^(-)and fungus,the AUC value of ROC curve was 0.965 with the combined identification,which was greater than the alone;when identifying G^(+)and fungus,the AUC value was 0.748 with IL-6;when identifying G^(-)and G^(+),the AUC value was 0.943 with IL-6,which was greater than HBP and pro-ADM alone(P<0.05).Conclusion The expression of serum HBP,IL-6,and pro-ADM in elderly patients with lung infection is positively correlated with the degree of infection,which may be used to identify different pathogens and guide the clinical development of targeted treatment.