摘要
目的探讨重症肺炎患者外周血单核细胞趋化蛋白-1(MCP-1)、涎液化糖链抗原-6(KL-6)、簇分化抗原64(CD64)指数对预后的预测价值及临床意义。方法选取该院2018年6月至2020年6月重症肺炎患者128例作为研究对象。研究对象根据28 d预后情况分为预后良好组(73例)与预后不良组(55例)。采用酶联免疫吸附试验法检测各组血清MCP-1、KL-6水平,采用赛默飞Attune NxT流式细胞仪检测中性粒细胞CD64、淋巴细胞CD64荧光强度,计算各组CD64指数。结果预后不良组年龄、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、临床肺部感染评分(CPIS)、合并症慢性阻塞性肺疾病和脓毒症占比,以及外周血MCP-1、KL-6、CD64指数高于预后良好组,差异有统计学意义(P<0.05)。COX回归分析显示,年龄、APACHEⅡ评分、CPIS、合并症脓毒症、外周血MCP-1、KL-6、CD64指数是重症肺炎患者预后不良的独立危险因素(P<0.05)。相关性分析,外周血MCP-1、KL-6、CD64指数与重症肺炎患者年龄、APACHEⅡ评分、CPIS、合并脓毒症等其他预后危险因素呈正相关(P<0.05)。受试者工作特征曲线分析显示,外周血MCP-1、KL-6、CD64指数联合预测预后不良的曲线下面积为0.876(95%CI:0.807~0.928),高于各指标单一预测。以外周血MCP-1、KL-6、CD64指数截断值为界分为阳性与阴性,外周血MCP-1、KL-6、CD64指数阳性患者28 d生存率低于阴性患者,且其死亡危险度分别是阴性患者的5.752倍(95%CI:2.544~26.912)、4.385倍(95%CI:2.138~8.992)、10.618倍(95%CI:3.406~33.097)。结论外周血MCP-1、KL-6、CD64指数联合检测可作为预测重症肺炎患者预后不良的新思路,还能为预测死亡风险提供可靠参考依据。
Objective To investigate the prognostic value of peripheral blood monocyte chemoattractant protein-1(MCP-1),sialic sugar chain antigen-6(KL-6)and cluster differentiation antigen 64(CD64)index in patients with severe pneumonia and clinical significance.Methods 128 patients with severe pneumonia from June 2018 to June 2020 were selected as subjects.The subjects were divided into good prognosis group(73 cases)and bad prognosis group(55 cases)according to the 28 days prognosis.Serum MCP-1 and KL-6 levels in each group were detected by enzyme-linked immunosorbent assay.Fluorescence intensity of CD64 in neutrophils and CD64 in lymphocytes was detected by Thermo Fisher Attune NxT flow cytometer,and CD64 index in each group was calculated.Results Age,acute physiological and chronic health evaluation systemⅡ(APACHEⅡ)score,clinical pulmonary infection score(CPIS),proportion of chronic obstructive pulmonary disease and sepsis,MCP-1,KL-6 and CD64 index in peripheral blood of poor prognosis group were higher than those of good prognosis group,and the differences were statistically significant(P<0.05).COX regression analysis showed that age,APACHEⅡscore,CPIS,sepsis,peripheral blood MCP-1,KL-6,and CD64 index were independent risk factors for poor prognosis in patients with severe pneumonia(P<0.05).Correlation analysis showed that peripheral blood MCP-1,KL-6,CD64 index were positively correlated with other prognostic risk factors such as age,APACHEⅡscore,CPIS and sepsis in patients with severe pneumonia(P<0.05).Subject operating characteristic curve analysis,the combination of peripheral blood MCP-1,KL-6,and CD64 index predicts poor prognosis AUC of 0.876(95%CI:0.807-0.928),which was higher than the single prediction of each index.The cut-off values of MCP-1,KL-6 and CD64 index in peripheral blood were divided into positive and negative.The 28-day survival rate of patients with positive peripheral blood MCP-1,KL-6,and CD64 index was lower than that of negative patients,and their mortality risk was 5.752 times of that of
作者
贾亚杰
JIA Yajie(Department of Intensive Care Medicine,Wuhan Puren Hospital,Wuhan,Hubei 430081,China)
出处
《国际检验医学杂志》
CAS
2023年第5期571-575,共5页
International Journal of Laboratory Medicine
基金
湖北省科技计划项目(2017FFB6317)。
关键词
重症肺炎
单核细胞趋化蛋白-1
涎液化糖链抗原-6
簇分化抗原64指数
预后
severe pneumonia
monocyte chemoattractant protein-1
sialic sugar chain antigen-6
cluster differentiation antigen 64 index
prognosis
