重症社区获得性肺炎患者血清1磷酸鞘氨醇受体3水平的变化及临床意义

The significance of serum sphingosine-1-phosphate receptor 3 in patients with severe community-acquired pneumonia

目的:探讨重症社区获得性肺炎(SCAP)患者血清1磷酸鞘氨醇受体3(S1PR3)水平的动态变化及临床意义。方法:选取2018年1月—2022年12月惠州市中心人民医院收治的67例重症社区获得性肺炎患者及同期轻症社区获得性肺炎患者33例。采用ELISA法测定67例重症肺炎患者入院后第1、4、7、10天血清S1PR3水平,同时计算第1天PSI评分,重症肺炎根据预后分为死亡组(n=31)和存活组(n=36)。结果:重症肺炎组S1PR3水平、PSI评分均明显高于轻症肺炎组,差异有统计学意义(P<0.05);肺炎严重指数(PSI)评分、血清S1PR3诊断重症肺炎的受试者工作特征(ROC)曲线下面积(AUC)分别为0.933、0.841;重症肺炎存活组S1PR3水平逐渐下降,死亡组S1PR3水平一度升高,后逐渐下降,总体呈下降趋势。存活组S1PR3下降幅度≥50%比例高于死亡组,差异有统计学意义(P<0.05)。结论:血清S1PR3可作为重症社区获得性肺炎患者的辅助诊断指标,动态监测S1PR3水平可以有效预测重症社区获得性肺炎患者的预后情况,如快速下降提示预后良好,治疗后水平升高或下降缓慢预示预后不良。

Objective To evaluate the dynamic monitoring of serum sphingosine-1-phosphate receptor 3(S1PR3)level in patients with severe community-acquired pneumonia(SCAP)and its clinical significance.Methods From January 2018 to December 2022,67 cases of severe community-acquired pneumonia and 33 cases of mild community-acquired pneumonia(MCAP)admitted to Huizhou Municipal Central Hospital were selected as the study subjects.The serum S1PR3 level on the 1st,4th,7th and 10th days after admission of 67 patients with SCAP was measured by ELISA method,and the Pneumonia Severity Index(PSI)score on day 1 was calculated,and SCAP was divided into death group(n=31)and survival group(n=36)according to prognosis.Results The S1PR3 level and PSI score in the SCAP group were significantly higher than those in the MCAP group,and the differences were statistically significant(P<0.05),the;PSI score and the area under the receiver operating characteristic(ROC)curve(AUC)of serum S1PR3 for the diagnosis of SCAP were 0.933 and 0.841,respectively.The decrease in S1PR3 in the survival group was higher(≥50%)than that in the death group,and the difference was statistically significant(P<0.05).Conclusion Serum S1PR3 can be used as an auxiliary diagnostic indicator for SCAP.Dynamic monitoring of S1PR3 level can effectively predict the prognosis.For example,a rapid decline indicated a good prognosis,while a slow decline or rise after treatment indicates a poor prognosis.