重症社区获得性肺炎患者PIV、IL-6、HBP、PAB水平对疗效的评估价值

doi:10.11958/20240710

摘要/Abstract

摘要：

目的分析重症社区获得性肺炎（CAP）患者的泛免疫炎症值（PIV）、白细胞介素（IL）-6、肝素结合蛋白（HBP）、前白蛋白（PAB）水平变化及其对入院72 h治疗效果的评估价值。方法 120例重症CAP患者（重症组）按照初始治疗效果分为有效组87例和失败组33例，另选取同期收治的非重症CAP患者120例为非重症组。比较重症组与非重症组、失败组与有效组入院次日PIV、IL-6、HBP及PAB水平，以受试者工作特征（ROC）曲线分析以上指标单独及联合检测对CAP病情及入院72 h治疗效果的评估价值。结果重症组PIV、IL-6及HBP水平高于非重症组，PAB水平低于非重症组（P<0.05）；ROC曲线分析示，单独检测时PIV评估重症CAP的曲线下面积（AUC）最高，为0.830（95% CI：0.780~0.881）；PIV联合IL-6、HBP及PAB评估重症CAP的AUC为0.929（95% CI：0.892~0.967），高于各单一指标检测（P<0.05）。失败组PIV、IL-6及HBP水平高于有效组，PAB水平低于有效组（P<0.05）；ROC曲线分析示，单独检测时PIV评估重症CAP入院72 h治疗效果的AUC最高，为0.777（95%CI：0.692~0.862）；PIV联合IL-6、HBP及PAB评估重症CAP入院72 h治疗效果的AUC为0.916（95%CI：0.846~0.986），高于各单一指标检测（P<0.05）。结论 PIV联合IL-6、HBP、PAB检测对CAP患者病情及重症CAP入院72 h治疗效果评估均具有良好的价值。

关键词: 白细胞介素6, 前白蛋白, 预后, ROC曲线, 社区获得性肺炎, 泛免疫炎症值, 肝素结合蛋白

Abstract:

Objective To analyze levels of pan-immune-inflammation value (PIV), interleukin-6 (IL-6), heparin-binding protein (HBP) and prealbumin (PAB) in patients with severe community-acquired pneumonia (CAP), and their values in evaluating the therapeutic effect at 72 h after admission. Methods According to the initial (72 h) treatment outcome, 120 patients with severe CAP (the severe group) were divided into the effective group (n=87) and the failed group (n=33). Meanwhile, 120 patients with non-severe CAP admitted in the same period were selected as the non-severe group. PIV, IL-6, HBP and PAB levels on the day after admission were compared between the severe group, the non-severe group, the failed group and the effective group. The value of above indicators in evaluating the condition of CAP and the therapeutic effect at 72 h after admission separately and in combination were analyzed using receiver operating characteristic (ROC) curves. Results Compared with the non-severe group, there were higher PIV, IL-6 and HBP levels, and lower PAB levels in the servere grouop (P<0.05). ROC curves indicated that for evaluating severe CAP using a single indicator, the area under the curve (AUC) of PIV was the highest [0.830 (95%CI: 0.780-0.881)]. The AUC of PIV combined with IL-6, HBP and PAB for evaluating severe CAP was 0.929 (95%CI: 0.892-0.967), which was higher than that of evaluation using a single indicator (P<0.05). Compared with the effective group, there were higher PIV, IL-6 and HBP levels, and lower PAB level in the failed group (P<0.05). ROC curves indicated that for evaluating the therapeutic effect on severe CAP at 72 h after admission using a single indicator the AUC of PIV was the highest [0.777 (95%CI: 0.692-0.862)]. The AUC of PIV combined with IL-6, HBP and PAB for evaluating the therapeutic effect on severe CAP at 72 h after admission was 0.916 (95%CI: 0.846-0.986), which was higher than that of evaluation using a single indicator (P<0.05). Conclusion Detection of PIV combined with IL-6, HBP and PAB has a good value in evaluating the condition of patients with CAP and the therapeutic effect on severe CAP at 72 h after admission.

Key words: interleukin-6, prealbumin, prognosis, ROC curve, community acquired pneumonia, pan immune inflammatory value, heparin binding protein

中图分类号:

R563.1

图/表 7

参考文献 20

[1]	HER Q L, DHOPESHWARKAR N, FEENEY T. Critique of "Angiotensin-converting enzyme inhibitors reduce community-acquired pneumonia hospitalization and mortality"[J]. Pharmacotherapy, 2023, 43(3):257-258. doi:10.1002/phar.2773.
[2]	TSAI D, CHIONG F, SECOMBE P, et al. Epidemiology and microbiology of severe community-acquired pneumonia in Central Australia:a retrospective study[J]. Intern Med J, 2022, 52(6):1048-1056. doi:10.1111/imj.15171.
[3]	邓龙, 王冉, 赵文俊, 等. 肝素结合蛋白对社区获得性肺炎诊断价值及预后评估[J]. 蚌埠医学院学报, 2022, 47(5):600-602,607.
	DENG L, WANG R, ZHAO W J, et al. Study on the diagnostic and prognostic evaluation value of heparin-binding protein in community-acquired pneumonia[J]. J Bengbu Med Coll, 2022, 47(5):600-602,607. doi:10.13898/j.cnki.issn.1000-2200.2022.05.010.
[4]	高建英, 曹文娟, 高原. D-二聚体,前白蛋白,可溶性髓系细胞触发受体-1对儿童重症肺炎的诊断价值[J]. 实用临床医药杂志, 2023, 27(7):108-112.
	GAO J Y, CAO W J, GAO Y. Values of D-dimer,prealbumin and soluble triggering receptor expressed on myeloid cells-1 in diagnosing severe pneumonia in children[J]. J Clin Med Pract, 2023, 27(7):108-112. doi:10.7619/jcmp.20223481.
[5]	倪子龙, 朱正秋, 周双, 等. 泛免疫炎症值与结直肠癌患者术后感染性并发症及预后的关系[J]. 现代肿瘤医学, 2024, 32(1):87-92.
	NI Z L, ZHU Z Q, ZHOU S, et al. Relationship between pan-immune-inflammation value and postoperative infectious complications and prognosis in patients with colorectal cancer[J]. J Mod Oncol, 2024, 32(1):87-92. doi:10.3969/j.issn.1672-4992.2024.01.015.
[6]	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J]. 中华结核和呼吸杂志, 2016, 39(4):253-279.
	Respiratory Society,Chinese Medical Association. Guidelines for the Diagnosis and Treatment of Community Acquired Pneumonia(2016 edition)[J]. Chin J Tuberc Respir Dis, 2016, 39(4):253-279. doi:10.3760/cma.j.issn.1001-0939.2016.04.005.
[7]	SALIH W, SCHEMBRI S, CHALMERS J D. Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observationaldata[J]. Eur Respir J, 2014, 43(3):842-851. doi:10.1183/09031936.00089513.
[8]	李玉, 尹晓. 肺部超声联合血清PCT、CRP对儿童社区获得性肺炎的诊断效能研究[J]. 影像科学与光化学, 2020, 38(4):676-680.
	LI Y, YIN X. The diagnostic efficacy of lung ultrasound combined with serum PCT and CRP on the community acquired pneumonia in children[J]. Imag Science Photochem, 2020, 38(4):676-680. doi:10.7517/issn.1674-0475.191221.
[9]	刘乔乔, 许能銮, 陈海燕, 等. 血小板参数,PDW/PLT和MPV/PLT变化对社区获得性肺炎患者预后评估价值[J]. 福建医科大学学报, 2020, 54(3):156-160.
	LIU Q Q, XU N L, CHEN H Y, et al. The clinical value of the change in platelet parameters,PDW/PLT and MPV/PLT in assessing the prognosis of community acquired pneumonia[J]. J Fujian Med Univ, 2020, 54(3):156-160. doi:10.3969/j.issn.1672-4194.220.03.005.
[10]	钟明媚, 徐康, 丁震, 等. 中性粒细胞/淋巴细胞比值与CURB-65评分在老年社区获得性肺炎预后评价中的作用[J]. 中华急诊医学杂志, 2021, 30(10):1235-1239.
	ZHONG M M, XU K, DING Z, et al. Predictive value of neutrophil to lymphocyte ratio and CURB-65 score in elderly patients with community acquired pneumonia[J]. Chin J Emerg Med, 2021, 30(10):1235-1239. doi:10.3760/cma.j.issn.1671-0282.2021.10.014.
[11]	何婧瑜, 王晶. 成人支原体肺炎患者凝血功能变化及其与外周血单核细胞百分比的相关性[J]. 中国急救医学, 2021, 41(3):191-195.
	HE J Y, WANG J. Relationship between the percentage of monocytes in peripheral blood and the changes of coagulation in adult mycoplasma pneumonia[J]. Chin J Crit Care Med, 2021, 41(3):191-195. doi:10.3969/j.issn.1002-1949.2021.03.002.
[12]	张玮宸, 裴玉芳. 流感患者外周血C反应蛋白,淋巴细胞与肺炎严重度指数的相关性分析[J]. 武警医学, 2020, 31(6):486-489.
	ZHANG W C, PEI Y F. Correlations between peripheral blood C-reactive protein,lymphocyte and pneumonia severity indexes in patients with influenza[J]. Med J Chin Peop Arm Pol For, 2020, 31(6):486-489. doi:10.3969/j.issn.1004-3594.2020.06.008.
[13]	王小琴, 王满侠, 王金萍, 等. 泛免疫炎症值预测收住重症监护病房的急性缺血性卒中患者的院内死亡[J]. 国际脑血管病杂志, 2023, 31(10):736-743.
	WANG X Q, WANG M X, WANG J P, et al. Pan-immune-inflammation value predicts in-hospital mortality in patients with acute ischemic stroke admitted to the intensive care units[J]. Int J Cerebrovasc Dis, 2023, 31(10):736-743. doi:10.3760/cma.j.issn.1673-4165.2023.10.003.
[14]	HAN H, MA Q, LI C, et al. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors[J]. Emerg Microbes Infect, 2020, 9(1):1123-1130. doi:10.1080/22221751.2020.1770129.
[15]	WANG H, ZHANG Y, ZHAO C, et al. Serum IL-17A and IL-6 in paediatric Mycoplasma pneumoniae pneumonia: implications for different endotypes[J]. Emerg Microbes Infect, 2024, 13(1):2324078. doi:10.1080/22221751.2024.2324078.
[16]	Gene delivery of interleukin 2 treats neuro-inflammation in traumatic brain injury[J]. Nat Immunol, 2022, 23(6):834-835. doi:10.1038/s41590-022-01209-y.
[17]	NICHOLS D C, FLANNERY A H, MAGNUSON B L, et al. Prealbumin is associated with in-hospital mortality in critically Ill patients[J]. Nutr Clin Pract, 2020, 35(3):572-577. doi:10.1002/ncp.10414.
[18]	ZHOU L, CHEN J, MU G, et al. Heparin-binding protein(HBP) worsens the severity of pancreatic necrosis via up-regulated M1 macrophages activation in acute pancreatitis mouse models[J]. Bioengineered, 2021, 12(2):11978-11986. doi:10.1080/21655979.2021.2011018.
[19]	CUI N, TONG H, LI Y, et al. Role of prealbumin in predicting the prognosis of severely and critically ill COVID-19 patients[J]. Am J Trop Med Hyg, 2021, 105(3):718-726. doi:10.4269/ajtmh.21-0234.
[20]	夏娴娴, 陈罡, 刘温馨. 社区获得性肺炎合并低蛋白血症的调查及危险因素分析[J]. 临床急诊杂志, 2020, 21(2):115-119.
	XIA X X, CHEN G, LIU W X. Investigation and risk fact ors analysis of community acquired pneumonia with hypoproteinemia[J]. J Clin Emerg, 2020, 21(2):115-119. doi:10.13201/j.issn.1009-5918.2020.02.004.

组别		n	性别（男/女）		年龄/岁		吸烟史
非重症组		120	62/58		64.40±6.80		32（26.7）
重症组		120	68/52		64.21±7.24		36（30.0）
χ²或t			0.604		0.211		0.328
组别	饮酒史			文化程度（A/B/C）		BMI/（kg/m²）
非重症组	43（35.8）			62/30/28		22.18±1.55
重症组	40（33.3）			65/28/27		22.39±1.48
χ²或t	0.166			0.158		1.079

组别		n	性别（男/女）		年龄/岁		吸烟史
非重症组		120	62/58		64.40±6.80		32（26.7）
重症组		120	68/52		64.21±7.24		36（30.0）
χ²或t			0.604		0.211		0.328
组别	饮酒史			文化程度（A/B/C）		BMI/（kg/m²）
非重症组	43（35.8）			62/30/28		22.18±1.55
重症组	40（33.3）			65/28/27		22.39±1.48
χ²或t	0.166			0.158		1.079

组别	PLT/（×10⁹/L）		NEU/（×10⁹/L）		MON/（×10⁹/L）		LYM/（×10⁹/L）
非重症组	136.58±16.59		6.68±1.44		0.59±0.79		1.43±0.16
重症组	118.40±11.71		8.11±1.10		0.74±0.13		1.28±0.20
t	9.807^＊＊		8.683^＊＊		10.606^＊＊		6.421^＊＊
组别		PIV		IL-6/（ng/L）		HBP/（μg/L）		PAB/（mg/L）
非重症组		382.47±113.95		83.07±15.98		19.85±5.00		181.28±20.64
重症组		572.02±168.17		100.96±11.24		25.32±3.57		155.46±20.28
t		10.222^＊＊		10.031^＊＊		9.767^＊＊		9.772^＊＊

组别	PLT/（×10⁹/L）		NEU/（×10⁹/L）		MON/（×10⁹/L）		LYM/（×10⁹/L）
非重症组	136.58±16.59		6.68±1.44		0.59±0.79		1.43±0.16
重症组	118.40±11.71		8.11±1.10		0.74±0.13		1.28±0.20
t	9.807^＊＊		8.683^＊＊		10.606^＊＊		6.421^＊＊
组别		PIV		IL-6/（ng/L）		HBP/（μg/L）		PAB/（mg/L）
非重症组		382.47±113.95		83.07±15.98		19.85±5.00		181.28±20.64
重症组		572.02±168.17		100.96±11.24		25.32±3.57		155.46±20.28
t		10.222^＊＊		10.031^＊＊		9.767^＊＊		9.772^＊＊

指标	AUC（95%CI）	截断值	敏感度/ %	特异度/ %	约登指数
PIV	0.830（0.780~0.881）	420.48	83.30	66.70	0.500
IL-6	0.828（0.777~0.880）	93.75 ng/L	76.70	75.00	0.517
HBP	0.810（0.756~0.864）	22.33 μg/L	82.50	68.30	0.508
PAB	0.810（0.757~0.863）	160.19 mg/L	86.70	60.00	0.467
指标联合	0.929（0.892~0.967）	-	93.30	92.50	0.858