血清HBP、IL-10、TNF-α、CRP水平与重症肺炎合并呼吸衰竭患者病情严重程度及预后的关系

Correlations of levels of HBP,IL-10,TNF-αand CRP in serum with severity and prognosis of severe pneumonia complicated by respiratory failure

目的探讨血清肝素结合蛋白(HBP)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平与重症肺炎合并呼吸衰竭患者病情严重程度及预后的关系。方法回顾性抽取2020年1月至2023年6月南阳市中心医院收治的肺炎患者89例纳入为A组,重症肺炎患者81例纳入B组,重症肺炎合并呼吸衰竭患者76例纳入C组。按照重症肺炎合并呼吸衰竭患者入院28 d后的生存情况,将其分为死亡组(25例)和存活组(51例)。比较三组(A、B、C组)血清HBP、IL-10、TNF-α、CRP水平及病情严重程度指标。应用Pearson检验分析血清HBP、IL-10、TNF-α、CRP水平与病情严重程度指标的相关性,计算受试者工作特征曲线下面积(AUC),分析HBP、IL-10、TNF-α、CRP单独及联合检测对重症肺炎合并呼吸衰竭患者预后的预测价值。结果三组(依次为A、B、C组)血清因子(HBP、TNF-α、IL-10、CRP)水平及病情严重程度指标[急性生理和慢性健康(APACHEⅡ)、序贯器官衰竭(SOFA)评分]呈升高趋势(P<0.05)。Pearson检验结果显示,血清HBP、IL-10、TNF-α、CRP水平与SOFA及APACHEⅡ呈正相关(r=0.58、0.42,0.45、0.39,0.40、0.37,0.34、0.54,P均<0.05)。存活组血清HBP、TNF-α、CRP水平低于死亡组,IL-10水平高于死亡组(P均<0.05)。HBP、IL-10、TNF-α、CRP单独及联合检测对重症肺炎合并呼吸衰竭患者预后的预测价值的AUC分别为0.718、0.736、0.742、0.772、0.921,敏感性分别为68.00%、84.00%、72.00%、80.00%、88.00%,特异性分别为70.59%、64.71%、66.67%、60.78%、92.16%,联合检测的相应值较高。结论重症肺炎合并呼吸衰竭患者HBP、TNF-α、CRP、IL-10水平升高,其与病情严重程度密切相关,四项指标联合检测对重症肺炎合并呼吸衰竭患者预后具有较高的预测价值。

ObjectiveTo investigate the correlations of levels of heparin-binding protein(HBP),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in serum with the severity and prognosis of severe pneumonia(SP)complicated by respiratory failure.MethodsA total of 89 patients with pneumonia admitted to Nanyang Central Hospital from January 2020 to June 2023 were retrospectively selected as the group A,in addition,81 patients with SP were included in the group B,and 76 patients with SP complicated by respiratory failure were included in the group C.According to the survival within 28 days after admission,the selected patients with SP complicated by respiratory failure were divided into the death group(25 cases)and the survival group(51 cases).The levels of serum HBP,IL-10,TNF-αand CRP in the three groups(groups A,B and C)were compared,and the severity of the disease in the three groups were compared.The Pearson test was used to analyze the correlations of the levels of serum HBP,IL-10,TNF-αand CRP with the severity of the disease.The area under the receiver operating characteristic curve(AUC)was calculated to analyze the predictive value of HBP,IL-10,TNF-α,CRP and combination of them on the prognosis of patients with SP complicated by respiratory failure.ResultsThe levels of serum factors,such as HBP,TNF-α,IL-10,and CRP,and the disease severity indicators,including acute physiology and chronic health(APACHEⅡ)and sequential organ failure(SOFA)scores,of the three groups showed an increasing trend in the order of groups A,B,and C(P<0.05).The results of Pearson test showed that the levels of serum HBP,IL-10,TNF-αand CRP were positively correlated with SOFA and APACHEII(r=0.58,0.42;0.45,0.39;0.40,0.37;0.34,0.54;all P<0.05).The levels of serum HBP,TNF-αand CRP in the survival group were lower than those in the death group,and the level of IL-10 in the survival group was higher than that in the death group(all P<0.05).The AUC values of HBP,IL-10,TNF-α,CRP and combination of them in predicting the prognosis of patients with SP complicated by respiratory failure were 0.718,0.736,0.742,0.772 and 0.921,the sensitivities were 68.00%,84.00%,72.00%,80.00%and 88.00%,correspondingly,and the specificities were 70.59%,64.71%,66.67%,60.78%and 92.16%,respectively.The combined detection had the higher values.ConclusionsThe levels of HBP,TNF-α,CRP and IL-10 increase in patients with SP complicated by respiratory failure,which are closely related to the severity of the disease;the combined detection has high prognostic value for SP complicated by respiratory failure.