血清VEGF、pro-ADM水平与老年呼吸机相关性肺炎病情严重程度及预后的关系

目的研究血清血管内皮生长因子(VEGF)、前肾上腺髓质素(pro-ADM)水平对老年呼吸机相关性肺炎(VAP)病情严重程度与预后的关系。方法选择本院2015年7月至2018年7月住院患者中机械通气的时间>2天的410例患者资料,有76例为VAP。按患者病情的严重程度分成低危组(26例)、中危组(30例)及高危组(20例),根据患者的临床结局分成存活组(57例)和死亡组(19例),采取ELISA方法测定各组血清VEGF及pro-ADM的水平,对各组的VEGF和pro-ADM水平差异以及两者之间的相关性进行比较,并评价血清VEGF、pro-ADM水平对VAP病情严重程度与预后的关系。结果VAP组的血清VEGF含量、pro-ADM较非VAP组显著升高(P<0.05);3组间血清的VEGF、pro-ADM水平比较结果:低危组<中危组<高危组,差异有统计学意义(P<0.05)。相关分析示:在VAP组中,患者的血清VEGF含量与pro-ADM含量呈正相关(r=0.864,P=0.000)。ROC曲线的分析显示:血清VEGF曲线下面积(ACU):0.804(95%CI:0.752~0.856),最佳工作点:130.8 pg/mL,此时则判定VAP患者的预后不良特异性为62.90%及敏感度为73.70%;pro-ADM ACU:0.748(95%CI:0.693~0.804),最佳工作点:3.12 nmol/L,此时则判定VAP患者的预后不良特异性为93.70%及敏感度为86.80%。结论在老年呼吸机相关性肺炎患者中,血清VEGF含量与pro-ADM含量呈正相关,VEGF含量越高,pro-ADM含量越高,患者的病情越重,其预后越差,通过联合检测血清VEGF与pro-ADM含量可有效预测老年呼吸机相关肺炎患者病情的严重程度和临床预后,有较高的实用价值。

Relationship between serum VEGF and pro-ADM levels and the severity and prognosis of elderly patients with ventilator-associated pneumonia

Objective To investigate the relationship between serum vascular endothelial growth factor(VEGF)and preadrenomedullin(pro-ADM)levels and the severity and prognosis of elderly ventilatorassociated pneumonia(VAP). Methods A total of 410 patients were recruited for this study. They were admitted to our hospital from July 2015 to July 2018 for a period of mechanical ventilation >2 days,of which76 were VAP. According to the severity of the disease,patients were divided into low-risk group(26 cases),intermediate-risk group(30 cases)and high-risk group(20 cases). Based on the clinical outcome,patients were divided into survival group(57 cases)and death group(19 cases). ELISA method was used to determine the serum VEGF and pro-ADM levels in each group. The differences in VEGF and pro-ADM levels in each group and the correlation between them were compared. The relationship between serum VEGF,pro-ADM levels and the severity of VAP and prognosis was evaluated. Results The serum VEGF and pro-ADM levels in the VAP group were significantly higher than those in the non-VAP group(P<0.05);among the three groups:low-risk group