血清FKN、APC与老年社区获得性肺炎患者病情和预后不良的关系

Relationship between Serum FKN,APC and the Pathogenetic Condition and Poor Prognosis in Elderly Patients with Community-Acquired Pneumonia

目的:探讨血清分形趋化因子(FKN)、活化蛋白C(APC)与老年社区获得性肺炎(CAP)患者病情和预后不良的关系。方法:选取2020年1月~2023年1月潍坊市人民医院收治的314例老年CAP患者为CAP组,根据病情程度分为低危组104例、中危组123例、高危组87例,根据入院30d生存状况分为死亡组65例和存活组249例,另选取同期100名体检健康老年人为对照组。采用酶联免疫吸附法检测血清FKN、APC水平。采用受试者工作特征(ROC)曲线分析血清FKN、APC水平对老年CAP患者预后不良的预测价值。通过多因素Logistic回归分析老年CAP患者预后不良的影响因素。结果:与对照组比较,CAP组血清FKN水平升高,APC水平降低(P<0.05)。低危组、中危组、高危组老年CAP患者血清FKN水平依次升高,APC水平依次降低(P<0.05)。多因素Logistic回归分析显示,病情高危、机械通气和C反应蛋白(CRP)、FKN升高为老年CAP患者预后不良的独立危险因素,APC升高为其独立保护因素(P<0.05)。ROC曲线分析显示,FKN、APC水平单独和联合预测老年CAP患者预后不良的曲线下面积分别为0.783、0.789、0.870,二者联合对老年CAP患者预后不良的预测价值大于各指标单独预测。结论:血清FKN水平升高和APC水平降低参与着老年CAP患者病情进展,血清FKN联合APC能较好地预测老年CAP患者预后不良。

Objective:To investigate the relationship between serum fractalkine(FKN),activated protein C(APC)and the pathogenetic condition and poor prognosis in elderly patients with community-acquired pneumonia(CAP).Methods:314 elderly CAP patients who were admitted to Weifang People's Hospital from January 2020 to January 2023 were selected as CAP group,patients were divided into low risk group(104 cases),medium risk group(123 cases)and high risk group(87 cases)according to the severity of the disease,patients were divided into death group(65 cases)and survival group(249 cases)according to the 30 days survival status after admission,another 100 healthy elderly people who underwent physical examination during the same period were selected as control group.Serum FKN and APC levels were detected by enzyme-linked immunosorbent assay.The predictive value of serum FKN and APC levels of poor prognosis in elderly CAP patients were analyzed by receiver operating characteristic(ROC)curve.The influencing factors of poor prognosis in elderly CAP patients were analyzed by multivariate logistic regression.Results:Compared with control group,serum FKN level increased in CAP group,and APC level decreased(P<0.05).Serum FKN levels of elderly CAP patients in low risk group,medium risk group and high risk group increased in turn,and APC levels decreased in turn(P<0.05).Multivariate Logistic regression analysis showed that,high risk of illness,mechanical ventilation and increased C-reactive protein(CRP)and FKN were independent risk factors of poor prognosis in elderly CAP patients,and the increase of APC was an independent protective factor(P<0.05).ROC curve analysis showed that,the area under the curve of FKN,APC levels alone and combined to predict poor prognosis in elderly CAP patients was 0.783,0.789 and 0.870 respectively,the predictive value of the combination of the two for the poor prognosis of elderly CAP patients is greater than that of each index alone.Conclusion:Elevated serum FKN levels and decreased APC levels are involved in the progression of elderly CAP patients,and Serum FKN combine with APC can better predict the poor prognosis of elderly CAP patients.