血清PCT、RAGE、sTREM-1表达水平与重症肺炎患者病情严重程度及预后的关系

目的探究血清降钙素原(PCT)、晚期糖化终产物受体(RAGE)、可溶性髓样细胞触发受体-1(sTREM-1)水平与重症肺炎患者病情严重程度及预后的关系。方法选择2016年3月至2019年2月我院呼吸内科收治的98例重症肺炎患者及100例普通肺炎作为研究对象,分别纳入重症肺炎组及普通肺炎组。根据是否合并多器官功能障碍综合征(MODS)将重症肺炎组患者分为单纯重症肺炎组及重症肺炎合并MODS组两个亚组;根据28d疾病转归情况分为存活组及死亡组。比较各组患者血清学指标差异,分析其与急性生理慢性健康评分(APACHEII)的相关性,并绘制ROC曲线分析其预测预后的价值。结果单纯重症肺炎组、重症肺炎合并MODS组患者血清PCT、RAGE、sTREM-1、C反应蛋白(CRP)水平显著高于普通肺炎组(P<0.05);重症肺炎合并MODS组患者各血清学指标及APACHEII评分显著高于单纯重症肺炎组患者(P<0.05);血清PCT、RAGE、sTREM-1水平与APACHEII呈正相关关系(P<0.05);入组重症肺炎组患者均获得治疗并随访,28d内死亡的患者39例,存活患者59例,死亡组患者血清PCT、RAGE、sTREM-1、CRP水平显著高于存活组患者(P<0.05);血清PCT、RAGE、sTREM-1、CRP预测预后的曲线下面积分别为0.713、0.776、0.809、0.701,其中sTREM-1曲线下面积最大,截点值为50.61 ng/L;4种指标联合预测的曲线下面积为0.901。结论血清PCT、RAGE、sTREM-1表达水平与重症肺炎患者病情严重程度相关,其水平高低可作为评估患者病情、预测预后的参考指标。

The Relationship Among Expression Levels of Serum PCT,RAGE and sTREM-1 and the Severity and Prognosis of Severe Pneumonia

Objective To investigate the relationships among levels of serum procalcitonin(PCT),receptor of advanced glycation end products(RAGE)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1),and the severity and prognosis of severe pneumonia.Methods 98 patients with severe pneumonia and 100 patients with common pneumonia who were admitted to the Department of Respiratory Medicine of the hospital from March,2016 to February,2019 were enrolled in the study.They were included in the severe pneumonia group and the common pneumonia group,respectively.Patients in the severe pneumonia group were further divided into the simple severe pneumonia group and severe pneumonia with MODS group according to whether the patient had a multiple organ dysfunction syndrome(MODS).According to the 28d disease outcome,they were also divided into the survival group and death group.Serological indexes were compared among groups,and their correlations with the acute physiological and chronic health evaluation(APACHEII)score was analyzed.The values of above indicators in predicting the prognosis were analyzed by ROC curve.Results Levels of serum PCT,RAGE,sTREM-1 and C-reactiveprotein(CRP)were significantly higher in the simple severe pneumonia group and the severe pneumonia with MODS group than the common pneumonia group(P<0.05).Serological indexes and APACHE II scores of the severe pneumonia with MODS group were significantly higher than those of the simple severe pneumonia group(P<0.05).Levels of serum PCT,RAGE,sTREM-1 and CRP were positively correlated with APACHE II score(P<0.05).Patients in the severe pneumonia group were treated and followed up.39 patients died and 59 patients survived within 28 days.Levels of serum PCT,RAGE and sTREM-1 in the death group were significantly higher than those in the survival group(P<0.05).The areas under the curves of serum PCT,RAGE,sTREM-1 and CRP for predicting the prognosis were 0.713,0.776,0.809 and 0.901,respectively.The area under the curve of sTREM-1 was the largest,and the cut-off value was 50.61 ng/L.The area under the curve for the joint prediction of the four indicators was 0.901.Conclusion The expression levels of serum PCT,RAGE and sTREM-1 are related to the severity of severe pneumonia.These indicators can be used as reference indexes for assessing the patients′condition and predicting prognosis.