血清Lp-PLA2、sIL-2R、PCT在肺炎支原体肺炎患者中的表达及对预后的预测价值

Expression of Serum Lp-PLA2,sIL-2R and PCT in Patients with Mycoplasma Pneumoniae-Pneumonia and Their Prognostic Value

目的探究肺炎支原体肺炎(MPP)患者血清脂蛋白磷脂酶A2(Lp-PLA2)、可溶性白细胞介素-2受体(sIL-2R)、降钙素原(PCT)水平变化及其对预后的预测价值。方法纳入2021年05月~2023年05月本院收治的82例成人MPP患者设为研究组,同期于本院体检的健康志愿者82例设为对照组。比较两组血清Lp-PLA2、sIL-2R、PCT水平及肺功能[潮气量(VT)、达峰时间比(tPTEF/TE)、呼出75%潮气量时间的瞬间流速/潮气呼气峰流速(TEF25/PTEF%)]。依据病情严重程度分为轻症者46例、重症者36例,比较其各血清指标水平及临床肺部感染评分(CPIS)、改良版英国医学研究委员会呼吸困难量表(mMRC)评分。分析血清Lp-PLA2、sIL-2R、PCT与肺功能、CPIS评分、mMRC评分、病情严重程度相关性。依据治疗后3周内预后情况分为预后不良者、预后良好者,比较治疗前、治疗3 d后血清Lp-PLA2、sIL-2R、PCT水平。采用受试者工作特征曲线(ROC)分析治疗3 d后各血清指标对预后不良的预测价值。结果研究组血清Lp-PLA2、sIL-2R、PCT水平高于对照组,VT、tPTEF/TE、TEF25/PTEF%低于对照组(P<0.05);重症者血清Lp-PLA2、sIL-2R、PCT水平及CPIS评分、mMRC评分高于轻症者(P<0.05);血清Lp-PLA2、sIL-2R、PCT与tPTEF/TE呈负相关,而与CPIS评分、mMRC评分、病情严重程度呈正相关(P<0.05);预后不良者血清Lp-PLA2、sIL-2R、PCT水平高于预后良好者(P<0.05);血清Lp-PLA2、sIL-2R、PCT联合预测预后不良的AUC大于单独指标预测(P<0.05)。结论MPP患者血清Lp-PLA2、sIL-2R、PCT水平升高,且与肺功能、病情严重程度密切相关,联合检测其水平对预后具有一定预测价值。

Objective To investigate the changes of serum lipoprotein phospholipase A2(Lp-PLA2),soluble interleukin-2 receptor(sIL-2R)and procalcitonin(PCT)levels in patients with mycoplasma pneumoniae pneumonia(MPP)and their predictive value for prognosis.Methods A total of 82 adult patients with MPP admitted to our hospital from May 2021 to May 2023 were included in the study group,and 82 healthy volunteers who underwent physical examination at our hospital during the same period were included in the control group.Serum Lp-PLA2,sIL-2R,PCT levels and lung function were compared between the two groups[tidal volume(VT),peak-to-peak ratio(tPTEF/TE),instantaneous flow rate of 75%tidal volume exhaled/tidal peak expiratory flow rate(TEF25/PTEF%)].According to the severity of the disease,46 cases were divided into mild cases and 36 cases were severe cases.The levels of serum indexes,clinical pulmonary infection score(CPIS)and the score of the modified British Medical Research Council dyspnea Scale(mMRC)were compared.Serum Lp-PLA2,sIL-2R,PCT were correlated with lung function,CPIS score,mMRC score and severity of disease.According to the prognosis within 3 weeks after treatment,they were divided into poor prognosis and good prognosis.Serum Lp-PLA2,sIL-2R and PCT levels were compared before treatment and 3 days after treatment.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of serum indexes for poor prognosis after 3 days of treatment.Results The serum levels of Lp-PLA2,sIL-2R and PCT in study group were higher than those in control group,while VT,tPTEF/TE and TEF25/PTEF%were lower than those in control group(P<0.05).The levels of serum Lp-PLA2,sIL-2R,PCT,CPIS score and mMRC score in severe patients were higher than those in mild patients(P<0.05).Serum Lp-PLA2,sIL-2R and PCT were negatively correlated with tPTEF/TE,but positively correlated with CPIS score,mMRC score and disease severity(P<0.05).The serum levels of Lp-PLA2,sIL-2R and PCT in patients with poor prognosis were higher than those in patients with good prognosis(P<0.05).The AUC of serum Lp-PLA2,sIL-2R and PCT combined predicted poor prognosis was greater than that predicted by single index(P<0.05).Conclusions Serum Lp-PLA2,sIL-2R and PCT levels are elevated in MPP patients,which are closely related to lung function and severity of the disease.The combined detection of their levels has certain prognostic value.