老年重症肺炎患者外周血D-D、CRP、Th17/Treg水平的临床意义

The clinical significance of D-D,CRP,Th17/Treg levels in peripheral blood of elderly patients with severe pneumonia

目的 探讨老年重症肺炎患者感染病原菌特征及外周血D-二聚体(D-D)、C反应蛋白(CRP)、辅助T细胞17/调节性T细胞(Th17/Treg)水平变化,并分析其对预后的预测价值。方法 选取2020年2月—2022年4月于本院诊治的100例老年重症肺炎患者为研究对象,分析其病原菌分布情况。根据急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)分为A组(n=28)、B组(n=37)、C组(n=35),检测各组外周血D-D、CRP、Th17/Treg水平,并分析其与APACHEⅡ评分的相关性。根据住院期间内预后情况分为病死者21例、存活者79例,对比不同预后患者临床资料及外周血D-D、CRP、Th17/Treg水平,采用Lasso-Logistic回归分析预后相关的独立影响因素,分析外周血D-D、CRP、Th17/Treg水平对预后的预测价值。结果 老年重症肺炎主要致病菌为革兰阴性菌,占比66.29%;B组、C组外周血D-D、CRP、Th17/Treg水平高于A组,且C组高于B组(P<0.05);外周血D-D、CRP、Th17/Treg与APACHEⅡ评分呈正相关(P<0.05);病死者外周血D-D、CRP、Th17/Treg水平高于存活者(P<0.05);D-D、CRP、Th17/Treg、APACHEⅡ评分、累及器官≥3个、年龄均为预后的独立危险因素(P<0.05);外周血D-D、CRP、Th17/Treg联合预测预后的曲线下面积(AUC)大于各指标单独预测(P<0.05)。结论 革兰阴性菌是老年重症肺炎主要致病菌,外周血D-D、CRP、Th17/Treg水平与病情严重程度密切相关,联合检测其水平对患者预后具有预测价值。

Objective To investigate the characteristics of infectious agents and changes in peripheral blood D-dimer(D-D),C-reactive protein(CRP),and helper T-cell 17/regulatory T-cell(Th17/Treg)levels in elderly patients with severe pneumonia,and to analyze their predictive value for prognosis.Methods One hundred elderly patients with severe pneumonia treated in our hospital from February 2020 to April 2022 were selected for the study,and their pathogenic bacteria distribution was analyzed.They were divided into groups A(n=28),B(n=37),and C(n=35)according to the Acute Physiology and Chronic Health Status Scoring SystemⅡ(APACHEⅡ).Peripheral blood D-D,CRP,and Th17/Treg levels were analyzed in each group and correlated with APACHEⅡscores.The prognosis was divided into 21 cases who died of disease and 79 cases who survived according to the prognosis within the hospitalization period.The clinical data and peripheral blood D-D,CRP,and Th17/Treg levels of patients with different prognosis were compared.Lasso-Logistic regression was used to analyze the independent influencing factors related to prognosis.The predictive value of peripheral blood D-D,CRP,and Th17/Treg levels on prognosis was analyzed.Results The main causative organisms of severe pneumonia in the elderly were Gram-negative bacteria,accounting for 66.29%;peripheral blood D-D,CRP,and Th17/Treg levels were higher in groups B and C than in group A,and higher in group C than in group B(P<0.05);peripheral blood D-D,CRP,and Th17/Treg were positively correlated with APACHEⅡscores(P<0.05).Peripheral blood D-D,CRP,and Th17/Treg levels were higher in those who died than in those who survived(P<0.05);D-D,CRP,Th17/Treg,APACHEⅡscore,involvement of≥3 organs,and age were all independent risk factors for prognosis(P<0.05);the AUC of peripheral blood D-D,CRP,and Th17/Treg combined to predict prognosis was greater than that of each indicators alone(P<0.05).Conclusion Gramnegative bacteria are the main causative agents of severe pneumonia in the elderly,and the levels of peripheral blood D-D,CRP,and Th17/Treg are closely related to the severity of the disease,and the combined detection of their levels has predictive value for patient prognosis.