血清SAA、PCT、TLR4、NF-κB联合检测对COPD急性加重期并院内获得性肺炎的评估价值

Assessment value of combined detection of serum SAA, PCT, TLR4, and NF-κB in acute exacerbation of COPD complicated with hospital acquired pneumonia

目的探讨血清淀粉样蛋白A(SAA)、降钙素原(PCT)、Toll样受体4(TLR4)、细胞核因子-κB(NF-κB)联合评估慢性阻塞性肺疾病(COPD)急性加重期并院内获得性肺炎的价值。方法选择2018年3月—2023年10月本院收治的513例COPD急性加重期患者为研究对象,于入院48 h检测血清SAA、PCT、TLR4、NF-κB水平。根据患者院内获得性肺炎发生情况,将其分为发生组与未发生组,统计发生组病原微生物分布情况。比较两组一般资料与血清SAA、PCT、TLR4、NF-κB水平;采用受试者工作特征(ROC)曲线分析血清SAA、PCT、TLR4、NF-κB联合评估COPD急性加重期并院内获得性肺炎的价值。结果院内获得性肺炎发生率为8.77%(45/513);在并发院内获得性肺炎患者中共培养出病原菌51株,革兰阳性菌、革兰阴性菌分别为13株(25.49%)、38株(74.51%);发生组血清SAA、PCT、TLR4、NF-κB水平高于未发生组(P<0.05);血清SAA、PCT、TLR4、NF-κB水平联合评估COPD急性加重期患者并院内获得性肺炎的灵敏度、特异度、曲线下面积(AUC)分别为93.33%、85.90%、0.951,联合评估的灵敏度高于单独评估,AUC亦高于单独评估(P<0.05),特异度与单独评估基本接近。结论血清SAA、PCT、TLR4、NF-κB联合检测对COPD急性加重期并院内获得性肺炎具有良好的评估价值。

Objective To explore the value of serum amyloid A(SAA),procalcitonin(PCT),toll like receptor 4(TLR4)and nuclear factor-κB(NF-κB)in combined detecting in evaluating acute exacerbation of chronic obstructive pulmonary disease(COPD)complicated with hospital acquired pneumonia.Methods 513 patients with acute exacerbation of COPD who were admitted to our hospital from March,2018 to October,2023 were selected as the research subjects,and the levels of serum SAA,PCT,TLR4 and NF-κB were detected at 48h after admission.According to the occurrence of hospital acquired pneumonia in patients,they were divided into an occurrence group and a non-occurrence group.The distribution of pathogenic microorganisms in the occurrence group was counted.The general data and the levels of serum SAA,PCT,TLR4 and NF-κB between two groups were compared.The value of combined detection of serum SAA,PCT,TLR4 and NF-κB in evaluating acute exacerbation of COPD complicated with hospital acquired pneumonia was analyzed by the receiver operating characteristic(ROC)curve.Results The incidence rate of hospital acquired pneumonia was 8.77%(45/513).A total of 51 strains of pathogenic bacteria were cultured in patients with hospital acquired pneumonia,including 13 strains of Gram-positive bacteria(25.49%)and 38 strains of Gram-negative bacteria(74.51%).The levels of serum SAA,PCT,TLR4 and NF-κB in the occurrence group were higher than the non-occurrence group(P<0.05).The sensitivity,specificity and area under curve(AUC)of combined detection of serum SAA,PCT,TLR4 and NF-κB levels in evaluating the hospital acquired pneumonia of patients with acute exacerbation of COPD were 93.33%,85.90%and 0.951 respectively,and the sensitivity of combined evaluation was higher than those of individual evaluation,and AUC was also higher than that of individual evaluation(P<0.05),but the specificity was basically similar to that of individual evaluation.Conclusions The joint detection of serum SAA,PCT,TLR4 and NF-κB has good evaluation value for acute exacerbation of COPD complicated with hospital acquired pneumonia.