呼吸机相关性肺炎患者血清NAMPT、YKL-40、sTREM-1水平与病情程度及预后的关系研究

Study on the Relationship between Serum NAMPT,YKL-40,sTREM-1 Levels and Disease Severity and Prognosis in Patients with Ventilator-Associated Pneumonia

目的:研究呼吸机相关性肺炎(VAP)患者血清烟酰胺磷酸核糖转移酶(NAMPT)、壳多糖酶3样蛋白1(YKL-40)、可溶性髓系细胞触发受体-1(sTREM-1)水平与病情程度及预后的关系。方法:选取我院2019年2月~2021年2月收治的120例VAP患者作为研究对象,将其按照病情程度分成低危组40例、中危组45例以及高危组35例,另取同期健康体检人员50例作为对照组,检测并比较各组血清NAMPT、YKL-40、sTREM-1水平。此外,将VAP患者按照28 d生存情况分成死亡组和生存组,比较两组各项基本资料、治疗情况以及血清NAMPT、YKL-40、sTREM-1水平,采用多因素Logistic回归分析VAP患者预后的影响因素。结果:VAP患者的血清NAMPT、YKL-40、sTREM-1水平均高于对照组体检人员,且VAP患者中上述三项血清指标水平随着病情程度的加重而升高(P<0.05)。死亡组患者血清NAMPT、YKL-40、sTREM-1水平均高于生存组患者(P<0.05)。单因素分析结果显示:年龄、合并糖尿病、体质量指数(BMI)、机械通气时间、预防性使用抗生素以及气管切开均与VAP患者预后有关(P<0.05)。多因素Logistic回归分析结果显示:年龄≥65岁、机械通气时间较长、未预防性使用抗生素、气管切开以及血清NAMPT、YKL-40、sTREM-1水平异常升高均是VAP患者预后的不利影响因素(均OR>1,P<0.05)。结论:血清NAMPT、YKL-40、sTREM-1水平与VAP患者的病情程度及预后密切相关,VAP患者的预后受到年龄、机械通气时间、抗生素使用、气管切开以及血清NAMPT、YKL-40、sTREM-1水平等因素影响。

Objective:To study the relationship between niacinamide phosphoribontransferase(NAMPT),chitosan glycosinase 3-like protein 1(YKL-40),soluble myeloid triggering receptor-1(sTREM-1)and disease severity and prognosis in patients with ventilator-associated pneumonia(VAP).Methods:A total of 120 patients with VAP who were admited to our hospital from February 2019 to February 2021 were selected as the research object.They were divided into 40 cases in the low-risk group,45 cases in the medium-risk group and 35 cases in the high-risk group according to the disease severity.50 healthy physical examination personnel in the same period were taken as the control group.The serum NAMPT,YKL-40 and sTREM-1 levels in each group were detected and compared.In addition,patients with VAP were divided into death group and survival group according to 28 day survival.The basic data,treatment situation and serum NAMPT,YKL-40 and sTREM-1 levels were compared between the two groups.The influencing factors of prognosis of patients with VAP were analyzed by multivariate Logistic regression.Results:The serum NAMPT,YKL-40 and sTREM-1 levels in patients with VAP were higher than those in control group physical examination personnel,and the levels of these three serum indexes were increased with the disease severity(P<0.05).The serum NAMPT,YKL-40 and sTREM-1 levels in death group patients were higher than those in survival group patients(P<0.05).Univariate analysis showed that age,diabetes mellitus,body mass Index(BMM),mechanical ventilation time,prophylactic use of antibiotics and tracheotomy were all correlated with prognosis of patients with VAP(P<0.05).Multivariate Logistic regression analysis showed that age≥65 years,long mechanical ventilation time,no prophylactic use of antibiotics,tracheotomy and abnormal elevation of serum NAMPT,YKL-40 and sTREM-1 levels were all adverse factors for prognosis of patients with VAP(all OR>1,P<0.05).Conclusion:Serum NAMPT,YKL-40 and sTREM-1 levels are closely correlated with the disease severity and prognosis of patients with VAP.The prognosis of patients with VAP is affected by age,mechanical ventilation time,antibiotic use,tracheotomy and serum levels of NAMPT,YKL-40 and STREM-1,etc.