血清CC16、IL-37、IL-6、CRP对肺炎合并呼吸衰竭患者预后的预测价值

Predictive value of serum CC16,IL-37,IL-6 and CRP levels for prognosis in patients with pneumonia complicating respiratory failure

目的探讨血清Clara细胞分泌蛋白16(CC16)、白细胞介素(IL)-37、IL-6、C反应蛋白(CRP)对肺炎合并呼吸衰竭患者预后的预测价值。方法选取洪湖市人民医院于2020年7月至2022年7月收治的117例肺炎合并呼吸衰竭患者作为研究组,根据患者恢复情况分为预后良好组和预后不良组。另选取同期洪湖市人民医院收治的113例未合并呼吸衰竭的肺炎患者作为对照组。采用酶联免疫吸附试验检测所有患者血清CC16、IL-37、IL-6、CRP水平;采用受试者工作特征(ROC)曲线分析血清CC16、IL-37、IL-6、CRP水平对肺炎合并呼吸衰竭患者预后的预测价值。结果与对照组相比,研究组血清CC16水平较低(P<0.05),血清IL-37、IL-6和CRP水平较高(P<0.05)。与预后良好组相比,预后不良组血清CC16水平较低(P<0.05),血清IL-37、IL-6和CRP水平较高(P<0.05)。预后不良组患者白细胞计数(WBC)、中性粒细胞计数(NEU)和急性生理与慢性健康状况评价Ⅱ(APACHEⅡ)评分均高于预后良好组(P<0.05)。ROC曲线分析结果显示,血清CC16、IL-37、IL-6、CRP 4项联合预测肺炎合并呼吸衰竭患者预后不良的AUC为0.934(95%CI:0.873~0.972),大于CC16、IL-37、IL-6、CRP单项预测的AUC[0.816(95%CI:0.734~0.882)、0.750(95%CI:0.662~0.825)、0.842(95%CI:0.763~0.902)、0.827(95%CI:0.746~0.890)],差异均有统计学意义(Z=2.598、2.771、1.976、1.981,P<0.05)。结论肺炎合并呼吸衰竭患者血清CC16水平较低,IL-37、IL-6和CRP水平较高,4项指标联合检测对肺炎合并呼吸衰竭患者预后不良具有较高的预测价值。

Objective To explore the predictive value of serum Clara cell secreted protein 16(CC16),interleukin-37(IL-37),IL-6 and C-reactive protein(CRP)for the prognosis in the patients with pneumonia complicating respiratory failure.Methods A total of 117 patients with pneumonia complicating respiratory failure admitted and treated in Honghu Municipal People′s Hospital from July 2020 to July 2022 were selected as the study group,and divided into the good prognosis group and poor prognosis group based on their recovery situation.Other 113 patients with pneumonia without complicating respiratory failure admitted and treated in this hospital during the same period were selected as the control group.The enzyme linked immunosorbent assay(ELISA)was used to detect the levels of serum CC16,IL-37,IL-6 and CRP in all patients;the receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum CC16,IL-37,IL-6 and CRP levels for the prognosis of the patients with pneumonia complicating respiratory failure.Results Compared with the control group,the serum CC16 level in the study group was lower(P<0.05),and serum IL-37,IL-6 and CRP levels were higher(P<0.05).Compared with the good prognosis group,the serum CC16 level in the poor prognosis group was lower(P<0.05),the serum IL-37,IL-6 and CRP levels were higher(P<0.05).The white blood cell count(WBC),neutrophil count(NEU)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of CC16,IL-37,IL-6 and CRP combination for predicting poor prognosis in the patients with pneumonia complicating respiratory failure was 0.934(95%CI:0.873-0.972),which was greater than AUC of CC16,IL-37,IL-6 and CRP alone for prediction[0.816(95%CI:0.734-0.882),0.750(95%CI:0.662-0.825),0.842(95%CI:0.763-0.902),0.827(95%CI:0.746-0.890)],and the differences were statistically significant(Z=2.598,2.771,1.976,1.981,P<0.05).Conclusion The serum CC16 level in the patients with pneumonia complicating respiratory failure is lower,and the IL-37,IL-6 and CRP levels are higher.The combined detection of these four indicators has higher predictive value for the poor prognosis in the patients with pneumonia complicating respiratory failure.