外周血OSM、sFLT-1对重症肺炎相关性脓毒症患者病情进展和预后评估价值

The Evaluation Value of OSM and sFLT-1 in Peripheral Blood in Progressionand Prognosis of Patients with Severe Pneumonia Relevance Sepsis

目的探讨分析外周血抑癌蛋白M(oncostatin M,OSM)、可溶性血管内皮生长因子受体(soluble fms-like tyrosine kinase-1,sFLT-1)对重症肺炎相关性脓毒症患者病情进展和预后评估价值。方法选取2020年10月至2022年10月我院重症监护室收治的106例重症肺炎继发脓毒症患者,入院后采用急性生理与慢性健康评分(acute physiology and chronic healthy evaluationⅡscore,APACHEⅡscore)评估患者病情严重程度,然后根据脓毒症患者入院28d后预后情况,将患者分为生存组72例和死亡组34例。入院时采集患者外周血血清样本,采用双夹心酶联免疫吸附法检测血清OSM水平,采用酶联免疫吸附法检测血清sFLT-1水平,比较血清OSM、sFLT-1水平差异情况,分析其水平与重症肺炎继发脓毒症患者病情及预后的关系。结果存活组和死亡组患者性别、年龄、平均动脉压、氧合指数、体温、白细胞计数差异无统计学意义(P>0.05);而死亡组患者入院时APACHEⅡ评分高于生存组(P<0.05)。死亡组患者血清OSM水平低于生存组,而sFLT-1水平高于生存组(P<0.05)。Pearson相关性分析结果显示,血清OSM与APACHEⅡ评分呈负相关关系(P<0.01),血清sFLT-1与APACHEⅡ评分呈正相关关系(P<0.01)。ROC曲线结果显示,血清OSM截断值为498.36pg/mL时,评估重症肺炎继发脓毒症患者预后的曲线下面积为0.76(95%CI 0.713~0.835),此时灵敏度为78.45%,特异性为71.36%;血清sFLT-1截断值为527.49ng/L时,评估重症肺炎继发脓毒症患者预后的曲线下面积为0.79(95%CI 0.742~0.869),此时灵敏度为80.25%,特异性为70.33%;二者联合检测评估重症肺炎继发脓毒症患者预后的曲线下面积为0.85(95%CI 0.812~0.924),此时灵敏度为88.37%,特异性为70.45%。结论重症肺炎继发脓毒症患者外周血OSM降低、sFLT-1升高,其水平与患者病情进展及预后密切相关,二者对评估重症肺炎继发脓毒症患者预后具有一定参考价值。

Objective To investigate the value of oncostatin M(OSM)and soluble fms-like tyrosine kinase-1(sFLT-1)in the evaluation of the progress and prognosis of the patient with severe pneumonia relevance sepsis.Methods 106 patients with relevance sepsis due to severe pneumonia admitted to the Intensive Care Unit of our hospital from October,2020 to October,2022 were selected.Acute Physiology and chronic HealthyEvaluationⅡscore,APACHEⅡscore(Apacheⅱscore)were used to evaluate the severity of the patients,and according to the prognosis of the patients 28 days after admission,these patients were divided into the survival group(72 cases)and death group(34 cases).The peripheral blood serum samples of patients were collected upon admission,and the serum OSM level was detected by double-sandwich ELISA,and the serum sFLT-1 level was detected by ELISA.Levels of serum OSM and sFLT-1 were compared,and the relationship between expression levels and the condition and prognosis of patients with severe pneumonia relevance sepsis was analyzed.Results There were no significant differences in gender,age,mean arterial pressure,oxygenation index,body temperature and white blood cell count between the survival group and death group(P>0.05).APACHEⅡscore in the death group was higher than that in the survival group(P<0.05).The serum OSM level in the death group was lower than that in the survival group,while the sFLT-1 level was higher than that in the survival group(P<0.05).Pearson correlation analysis showed that serum OSM was negatively correlated with APACHEⅡscore(P<0.01),while serum sFLT-1 was positively correlated with APACHEⅡscore(P<0.01).ROC curve results showed that when serum OSM cutoff value was 498.36 pg/mL,the area under the curve to evaluate the prognosis of patients with severe pneumonia relevance sepsis was 0.76(95%CI 0.713-0.835),and the sensitivity and specificity were 78.45%and 71.36%,respectively.When the cutoff value of serum sFLT-1 was 527.49 ng/L,the area under the curve to evaluate the prognosis of patients with severe pneumonia relevance sepsis was 0.79(95%CI 0.742-0.869),and the sensitivity and specificity were 80.25%and 70.33%,respectively.For combined test,the area under the curve was 0.85(95%CI 0.812-0.924),the sensitivity was 88.37%,and the specificity was 70.45%.Conclusion Serum OSM decreases and sFLT-1 increases in patients with severe pneumonia relevance sepsis,which are closely related to the disease progression and prognosis of patients,and both have potential values as prognosis biomarkers for patients with severe pneumonia relevance sepsis.