重症监护病房老年重症社区获得性肺炎患者血小板、凝血功能指标、白细胞介素6水平及其临床意义

Levels of platelet,coagulation function and interleukin-6 in elderly patients with severe community-acquired pneumonia in intensive care unit and their clinical significance

目的探讨重症监护病房(ICU)老年重症社区获得性肺炎(CAP)患者血小板(PLT)、凝血功能指标及血清白细胞介素6(IL-6)水平,分析其临床意义。方法选取自2021年4月至2023年4月乐山市中医医院ICU收治的老年(年龄>60岁)重症CAP患者96例为重症组,选取同期体检正常的老年体检者76例为正常组。根据重症CAP患者自入院起6个月后的生存情况判定预后,将患者分为存活组(n=58)与死亡组(n=38)。检测PLT、部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)以及血清IL-6表达水平。采用Spearman相关性分析对老年重症CAP患者PLT、IL-6水平与凝血功能指标的相关性进行分析。绘制受试者工作特征(ROC)曲线,分析PLT、IL-6及凝血功能指标预测老年重症CAP患者预后的价值。结果重症组PLT水平低于正常组,APTT、PT和IL-6水平高于正常组,差异有统计学意义(P<0.05)。死亡组PLT水平低于存活组,APTT、PT、IL-6水平高于存活组,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,ICU老年重症CAP患者PLT与APTT、PT呈负相关(r=-0.665,P<0.05;r=-0.528,P<0.05);ICU老年重症CAP患者IL-6与APTT、PT呈正相关(r=0.591,P<0.05;r=0.602,P<0.05)。ROC曲线结果显示,PLT、IL-6、APTT和PT的ROC曲线下面积分别为0.949(95%可信区间:0.884~0.983,P<0.05)、0.874(95%可信区间:0.790~0.933,P<0.05)、0.840(95%可信区间:0.751~0.907,P<0.05)、0.740(95%可信区间:0.640~0.824,P<0.05)。结论PLT、凝血功能指标(APTT、PT)及IL-6水平可用于评估ICU老年重症CAP患者的预后。

Objective To investigate the levels of platelet(PLT),coagulation function and serum interleukin-6(IL-6)in elderly patients with severe severe community-acquired pneumonia(CAP)in intensive care unit(ICU),and analyze their clinical significance.Methods A total of 96 elderly patients(age>60 years)with severe CAP admitted to ICU of Leshan Traditional Chinese Medicine Hospital from April 2021 to April 2023 were selected as the severe group,and 76 elderly patients with normal physical examination during the same period were selected as the normal group.According to the survival of patients with severe CAP at 6 months after admission,the patients with severe CAP were divided into survival group(n=58)and death group(n=38).PLT,activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB)and serum IL-6 expression levels were detected.Spearman correlation analysis was used to analyze the correlation between PLT,IL-6 levels and coagulation function indexes in elderly patients with severe CAP.Receiver operating characteristic(ROC)curve was used to analyze the value of PLT,IL-6 and coagulation function indexes to predict the prognosis of elderly patients with severe CAP.Results The level of PLT in the severe group was lower than that in the normal group,and the levels of APTT,PT and IL-6 were higher than those in the normal group,with statistical significance(P<0.05).The level of PLT in the death group was lower than that in the survival group,the levels of APTT,PT and IL-6 were higher than those in the survival group,with statistical significance(P<0.05).Spearman correlation analysis showed that PLT was negatively correlated with APTT and PT in ICU elderly patients with severe CAP(r=-0.665,P<0.05;r=-0.528,P<0.05).IL-6 was positively correlated with APTT and PT in ICU elderly patients with severe CAP(r=0.591,P<0.05;r=0.602,P<0.05).ROC curve results showed that the areas under the ROC curves of PLT,IL-6,APTT and PT were 0.949[95%confidence interval(CI):0.8840.983,P<0.05],0.874(95%CI:0.790-0.933,P<0.05),0.840(95%CI:0.751-0.907,P<0.05)and 0.740(95%CI:0.640-0.824,P<0.05),respectively.Conclusion PLT,coagulation function indexes(APTT,PT)and IL-6 levels can be used to evaluate the prognosis of elderly patients with severe CAP in ICU.