血清胆碱酯酶和视黄醇结合蛋白联合检测对呼吸机相关性肺炎临床诊断价值分析

Analysis of clinical value of serum cholinesterase and retinol-binding protein combined detection in the diagnosis of ventilator-associated pneumonia

目的分析血清胆碱酯酶(ChE)和视黄醇结合蛋白(RBP)联合检测对呼吸机相关性肺炎(VAP)的临床诊断价值。方法选取2020年4月至2022年4月于淮安市第五人民医院和徐州医科大学附属医院进行有创机械通气治疗的192例患者为研究对象,分为VAP组和非VAP组。采用酶联免疫法检测血清ChE和RBP水平;Pearson法分析血清ChE、RBP水平及与肺部感染指数(CPIS)评分的相关性;Logistic回归分析有创机械通气患者发生VAP的影响因素;受试者工作特征(ROC)曲线分析血清ChE、RBP水平诊断VAP的截断值;采用四格表分析ChE、RBP以及两者联合对有创机械通气患者发生VAP的鉴别价值。结果VAP组血清ChE水平显著低于非VAP组,血清RBP水平及CPIS评分显著高于非VAP组(均P<0.05)。VAP组患者血清ChE水平与CPIS评分呈负相关,血清RBP水平与CPIS评分呈正相关,血清ChE与RBP水平呈负相关(均P<0.05)。ChE低表达组、RBP高表达组的白细胞计数、机械通气时间显著高于ChE高表达组、RBP低表达组(P<0.05)。RBP、白细胞计数是影响VAP发生的独立危险因素(P<0.05)。ChE是影响VAP发生的独立保护因素(P<0.05)。血清ChE水平诊断有创机械通气患者发生VAP的AUC为0.832,截断值为4279.17 U/L,血清RBP水平诊断的AUC为0.830,截断值为37.27 mg/L。血清ChE和RBP二者联合诊断VAP的AUC为0.899(95%CI:0.845~0.954),准确度和灵敏度优于各自单独诊断。结论VAP组血清ChE水平显著低于非VAP组,RBP水平显著高于非VAP组,且两者联合对于VAP具有较高的诊断价值。

Objective To analyze the clinical diagnostic value of combined detection of serum cholinesterase(ChE)and retinol-binding protein(RBP)for ventilator-associated pneumonia.Methods From April 2020 to April 2022,192 patients who underwent invasive mechanical ventilation therapy in the Fifth People′s Hospital of Huai′an and the Affiliated Hospital of Xuzhou Medical University were selected as the study subjects and were divided into VAP group and non-VAP group.Serum ChE and RBP levels were detected by ELISA;the Pearson method was applied to analyze the levels of serum ChE and RBP,and their correlation with CPIS score;Logistic regression analysis was applied to analyze the influencing factors of VAP in patients with invasive mechanical ventilation;Receiver operating characteristic(ROC)curve was used to analyze the cut-off values of serum ChE and RBP levels in diagnosing VAP.The value of ChE,RBP,and their combination in differentiating VAP in patients with invasive mechanical ventilation was analyzed using the four-cell table.Results The serum ChE level in the VAP group was significantly lower than that in the non-VAP group,and the serum RBP level and CPIS score were significantly higher than those in the non-VAP group(all P<0.05).Serum ChE levels were negatively correlated with CPIS scores,serum RBP levels were positively correlated with CPIS scores,and serum ChE was negatively correlated with RBP levels(all P<0.05).The white blood cell counts and mechanical ventilation time of the ChE low expression group and RBP high expression group were obviously higher than those of the ChE high expression group and RBP low expression group(P<0.05).ChE,RBP and white blood cell count were independent risk factors for VAP(P<0.05).ChE is an indeperdent protective factor for VAP(P<0.05).The AUC of VAP in patients with invasive mechanical ventilation diagnosed by serum ChE level was 0.832,the cut-off value was 4279.17 U/L,and the AUC of patients diagnosed by serum RBP level was 0.830,the cut-off value was 37.27 mg/L.The AUC of serum ChE and RBP for the combined diagnosis of VAP was 0.899(95%CI:0.845~0.954),and the accuracy and sensitivity were better than those of each individual diagnosis.Conclusion The serum ChE level in the VAP group is significantly lower than that in the non-VAP group,and the level of RBP is significantly higher than that in the non-VAP group,and the combination of the two has a high diagnostic value for VAP.