慢性阻塞性肺疾病机械通气患者肺泡灌洗液和血清C反应蛋白、降钙素原、白细胞介素6表达及其临床意义

Expressions of C-reactive protein,procalcitonin and interleukin-6 in bronchoalveolar lavage fluid and serum of patients with chronic obstructive pulmonary disease undergoing mechanical ventilation and their clinical significance

目的研究慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)机械通气患者肺泡灌洗液(bronchoalveolar lavage fluid,BALF)和血清C反应蛋白(C reactive protein,CRP)、降钙素原、白细胞介素(Interleukin,IL)6表达及其临床价值。方法以成都市第三人民医院2022年9月至2023年9月收治的128例COPD机械通气患者为研究对象,根据是否发生呼吸机相关性肺炎(ventilator associated pneumonia,VAP)分为VAP组和非VAP组。比较两组间BALF和血清中CRP、降钙素原、IL-6表达差异,符合正态分布的计量资料以x^(-)±s表示,采用独立样本t检验进行组间均数比较;计数资料以构成比表示,组间比较采用χ^(2)检验。采用多因素COX回归分析COPD患者发生VAP的影响因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估BALF和血清中CRP、降钙素原、IL-6对VAP的诊断价值。结果128例COPD机械通气患者中出现32例VAP,96例非VAP。VAP组机械通气时间(5.12±0.48)d,3个月内使用抗生素13例(40.63%);非VAP组分别为(4.79±0.69)d和56例(61.46%),两组比较差异均有统计学意义(t=2.51,χ^(2)=4.23,均P<0.05)。VAP组患者BALF标本中CRP、降钙素原、IL-6表达水平分别为(26.46±6.78)mg/L、(2.47±0.69)ng/L和(751.46±126.44)μg/L,非VAP组分别为(20.47±6.26)mg/L、(1.12±0.32)ng/L和(447.89±68.69)μg/L,两组比较差异均有统计学意义(t值分别为4.59、15.00、17.18,均P<0.001);VAP组患者血清标本中CRP、降钙素原、IL-6表达水平分别为(124.78±26.32)mg/L、(10.53±2.20)ng/L和(221.69±45.46)μg/L,非VAP组分别为(96.78±24.96)mg/L、(6.46±1.89)ng/L和(146.36±42.34)μg/L,两组比较差异均有统计学意义(t值分别为5.42、10.12、8.56,均P<0.001);多因素COX回归分析显示机械通气时间,BALF和血清中CRP、降钙素原、IL-6是影响COPD患者发生VAP的独立因素(OR值分别为1.578、1.687、1.669、1.844、1.645、1.775、1.659,95%CI分别为1.017~2.447、1.066~2.669、1.076~2.588、1.148~2.963、1.086~2.493、1.172~2.690和1.084~2.538,均P<0.05);ROC曲线显示,BALF和血清中CRP、降钙素原、IL-6的AUC分别为0.758/0.792、0.965/0.930、0.977/0.900(P值分别为0.049/0.046、0.030/0.030、0.021/0.033)。结论COPD机械通气患者BALF和血清CRP、降钙素原、IL-6表达具有较高的临床诊断价值,可辅助早期VAP诊断。

ObjectiveTo study the expressions of bronchoalveolar lavage fluid(BALF),C-reactive protein(C reactive protein,CRP),procalcitonin(PCT)and Interleukin 6(IL-6)in mechanically ventilated patients with chronic obstructive pulmonary diseases(COPD)and their clinical significance.MethodsA total of 128 COPD patients with mechanical ventilation admitted to the Third People's Hospital of Chengdu from September 2022 to September 2023 were selected as the study subjects.They were divided into VAP group and non-VAP group according to the occurrence of ventilator associated pneumonia(VAP).Comparison of general data between the two groups,measurement data in line with normal distribution were expressed x^(-)±s,and independent sample t test was used to compare the mean between groups.Enumeration data were expressed as constituent ratio,andχ^(2) test was used to compare between groups.Multivariate Cox regression was used to analyze the influencing factors of VAP in COPD patients.The diagnostic value of CRP,procalcitonin and IL-6 in BALF and serum for VAP was evaluated by receiver operating characteristic(ROC)curve.ResultsThere were 32 cases of VAP and 96 cases of non-VAP in 128 COPD patients with mechanical ventilation.In the VAP group,the duration of mechanical ventilation was(5.12±0.48)days,and 13 patients(40.63%)had used antibiotics within 3 months,while in the non-VAP group,the duration of mechanical ventilation was(4.79±0.69)days,and 56 patients(61.46%)had used antibiotics within 3 months,respectively.There were significant differences between the two groups(t=2.51,χ^(2)=4.23,all P<0.05).The levels of CRP,procalcitonin and IL-6 in BALF of VAP group were(26.46±6.78)mg/L,(2.47±0.69)ng/L and(751.46±126.44),and in the non-VAP group,they were(20.47±6.26)mg/L,(1.12±0.32)ng/L and(447.89±68.69)μg/L,respectively.There were significant differences between the two groups(t=4.59,15.00,17.18,all P<0.001).The serum levels of CRP,procalcitonin and IL-6 in VAP group were(124.78±26.32)mg/L,(10.53±2.20)ng/L and(221.69±45.46).The non-VAP group was(96.78±24.96)mg/L,(6.46±1.89)ng/L and(146.36±42.34)μg/L,respectively(t=5.42,10.12,8.56;all P<0.001).Multivariate Cox regression analysis showed that mechanical ventilation time,BALF and serum CRP,procalcitonin and IL-6 were independent factors affecting the occurrence of VAP in COPD patients(OR values were 1.578,1.687,1.669,1.844,1.645,1.775 and 1.659,respectively).95%CI were 1.017-2.447,1.066-2.669,1.076-2.588,1.148-2.963,1.086-2.493,1.172-2.690 and 1.084-2.538,all P<0.05.ROC curve showed that the AUC of CRP,procalcitonin and IL-6 in BALF and serum were 0.758/0.792,0.965/0.930 and 0.977/0.900 respectively(P values were 0.049/0.046,0.030/0.030 and 0.021/0.033,respectively).ConclusionThe expressions of CRP,procalcitonin and IL-6 in BALF and serum of COPD patients with mechanical ventilation have high clinical diagnostic value,which can assist the diagnosis of early VAP.