摘要
目的 分析血清胆碱酯酶(ChE)、多配体蛋白聚糖-1(Syndecan-1)水平对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸机相关性肺炎(VAP)患者病情及预后的评估价值。方法 选取2022年1月至2024年1月淮安市第五人民医院收治的AECOPD合并VAP患者132例(设为AECOPD合并VAP组),另选择同期COPD稳定期患者70例(设为COPD稳定期组)和同期体检健康者70例(设为对照组),比较3组血清ChE、Syndecan-1水平。根据急性生理和慢性健康评分系统Ⅱ(APACHEⅡ)评分将AECOPD合并VAP患者分为低危VAP组(42例)、中危VAP组(44例)、高危VAP组(46例),分析血清ChE、Syndecan-1水平与AECOPD合并VAP患者APACHEⅡ评分的相关性。根据28 d预后分为死亡组(52例)和存活组(80例),比较3组ChE、Syndecan-1水平,并收集AECOPD合并VAP患者基线资料,绘制受试者工作特征(ROC)曲线,分析CHE、Syndecan-1水平评估AECOPD合并VAP患者不良预后的价值。结果 血清ChE水平AECOPD合并VAP组低于COPD稳定期组低于对照组,血清Syndecan-1水平AECOPD合并VAP组高于COPD稳定期组高于对照组(P <0.05),低、中、高危VAP组血清ChE水平依次降低,Syndecan-1水平依次降低(P <0.05)。AECOPD合并VAP患者APACHEⅡ评分与血清ChE水平呈负相关,与血清Syndecan-1水平呈正相关(P <0.05)。APACHEⅡ评分增加、降钙素原升高、Syndecan-1升高为AECOPD合并VAP患者不良预后的独立危险因素,第1秒用力呼气容积占预计值百分比升高、ChE升高为独立保护因素(P <0.05)。血清ChE联合Syndecan-1水平评估AECOPD合并VAP患者不良预后的曲线下面积为0.882,大于血清ChE、Syndecan-1水平单独评估的0.800、0.794(P <0.05)。结论 血清ChE水平降低和Syndecan-1升高与AECOPD合并VAP患者病情加重和预后不良有关,血清ChE联合Syndecan-1水平评估AECOPD合并VAP患者预后的价值较高。
Objective To investigate the value of serum cholinesterase(ChE)and Syndecan-1 levels in assessing the condition and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with ventilator-associated pneumonia(VAP).Methods A total of 132 patients with AECOPD combined with VAP were selected and divided into the low-risk VAP group(42 cases),the medium-risk VAP group(44 cases),and the high-risk VAP group(46 cases)based on their acute physiological and chronic health evaluation II(APACHE II)scores.Additionally,the patients were categorized into the death group(52 cases)and the survival group(80 cases)according to their 28-day prognosis.Serum ChE and Syndecan-1 levels were measured using enzyme-linked immunosorbent assay(ELISA).Results Serum ChE levels decreased sequentially,while Syndecan-1 levels increased sequentially,in the low-risk,medium-risk,and high-risk VAP groups(P<0.05).The APACHE II scores of patients with AECOPD combined with VAP were negatively correlated with serum ChE levels and positively correlated with serum Syndecan-1 levels(P<0.05).The serum ChE level in the death group was lower than that in the survival group,whereas the Syndecan-1 level was higher,with a statistically significant difference(P<0.05).The area under the curve(AUC)for assessing poor prognosis in patients with AECOPD combined with VAP,when considering serum ChE combined with Syndecan-1 levels,was greater than that when considering serum ChE or Syndecan-1 levels alone(P<0.05).Conclusion Decreased serum ChE levels and increased Syndecan - 1 levels were associated with disease exacerbation and poor prognosis inpatients with AECOPD combined with VAP. The combined assessment of serum ChE and Syndecan - 1 levels was of high value inpredicting the prognosis of these patients.
作者
胡中英
HU Zhongying(The Fifth People's Hospital of Huai'an,Huai'an,Jiangsu 223300,China)
出处
《转化医学杂志》
2024年第3期371-375,380,共6页
Translational Medicine Journal
