摘要
【目的】探讨血清单核细胞趋化蛋白-l(MCP-l)、高迁移率族蛋白l(HMGB1)对慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸机相关性肺炎患者预后的预测价值。【方法】选取2018年8月至2021年6月在本院诊治的83例AECOPD并发呼吸机相关性肺炎患者作为研究对象,收集患者的基础资料,并在患者入组后24 h内检测血清MCP-1、HMGB1的表达水平,根据患者随访1个月内的生存情况分为生存组及死亡组。以Logistic多因素回归分析AECOPD并发呼吸机相关性肺炎患者临床预后的影响因素,以受试者工作特征曲线(ROC)评估血清MCP-1、HMGB1水平对AECOPD并发呼吸机相关性肺炎患者临床预后的预测价值。【结果】本研究83例AECOPD并发呼吸机相关性肺炎患者中,其中19例患者治疗无效死亡(死亡组),占比22.89%(19/83);生存患者64例(生存组),占比77.11%(64/83)。死亡组患者急性生理和慢性健康状况(APACHE n)评分>20分、器官衰竭(SOFA)评分>6分、机械通气时间≥72 h所占比例及血清MCP-1、HMGB1水平均显著高于生存组,其差异有统计学意义(P<0.05)。Logistic多因素回归分析结果显示:A-PACHEU评分>20分、SOFA评分>6分、机械通气时间≥72 h、血清MCP-1及HMGB1表达水平偏高均为AECOPD并发呼吸机相关性肺炎患者死亡的危险因素(P<0.05);ROC分析结果显示:血清MCP-1及HMGB1水平单一及联合预测AECOPD并发呼吸机相关性肺炎患者临床预后的曲线下面积(AUC)分别为0.774、0.743、0.848。血清MCP-1及HMGB1水平单一检测对AECOPD并发呼吸机相关性肺炎患者临床预后的预测效能显著低于两者联合检测(P<0.05)。【结论】APACHEI1、SOFA评分偏高、机械通气时间较长的AECOPD并发呼吸机相关性肺炎患者死亡率越高;血清MCP-1、HMGB1对AECOPD并发呼吸机相关性肺炎患者的预后具有一定的临床预测价值。
【Objective】To analyze the predictive value of serum monocyte chemoattractant protein-1(MCP-1)and high mobility group protein 1(HMGB1)in the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with ventilator-associated pneumonia.【Methods】A total of 83 pa-tients with AECOPD complicated with ventilator-associated pneumonia admitted to the first affiliated hospital of Anhui medical university from August 2018 to June 2021 were selected as the research objects.Basic data of all patients were collected and vserological indexes[MCP-1 and HMGB1]of patients were detected within 24h.Patients were divided into the survival group and the death group according to the survival status within 1 month of follow-up.Logistic multivariate regression analysis was used to explore the relevant factors affecting the clinical prognosis of patients with AECOPD complicated with ventilator-associated pneumonia.The receiver operating characteristic curve(ROC)was used to determine the level of serum MCP-1 and HMGB1 for predicting clinical effects and prognosis of AECOPD with ventilator-associated pneumonia.【Results】Among the 83 patients with AECOPD complicated with ventilator-as-sociated pneumonia in this study,19 patients died of ineffective treatment(he death group),accounting for 22.89%(19/83)and 64 surviving patients(the survival group),accounting for 77.11%.The acute physiological and chronic health status(APACHEH)score>20 points,the organ failure(SOFA)score>6 points,the proportion of mechanical ventilation time≥72 h and the serum MCP-1 and HMGB1 levels in patients of the death group were higher than those in the survival group.The difference was statistically significant(P<0.05).Logistic multivariate regression a-nalysis showed that APACHEU score>20 points,SOFA score>6 points,mechanical ventilation time≥72 h,higher serum MCP-1 and HMGB1 expression levels were ri.sk factors for death in patients with AECOPD complicated with ventilator-associated pneumonia(P<0.05).ROC analysis showed that the area under the curve(AUC)of single and combined serum MCP-1 and HMGB1 levels for clinical prognosis of patients with AECOPD complicated with ventilator-associated pneumonia were 0.774,0.743 and 0.848 respectively.The efficacy of serum MCP-1 and HMGB1 levels alone in predicting the clinical prognosis of patients with AECOPD complicated with ventilator-associated pneu-monia was lower than that of the combination of the two(P<0.05).【Conclusion】Patients with AECOPD compli-cated with ventilator-associated pneumonia with high APACHEU and SOFA scores plus longer mechanical ventilation are more likely to have a prognosis of death.Serum MCP-1 and HMGB1 have certain clinical predictive value for the prognosis of patients with AECOPD complicated with ventilator-associated pneumonia.
作者
丁颖楠
尤青海
DING Ying-nan;YOU Qing-hai(Department of Respiratory and Critical Cure Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei Anhui,230022)
出处
《医学临床研究》
CAS
2021年第11期1639-1642,1646,共5页
Journal of Clinical Research
作者简介
通讯作者:尤青海,E-mail:amormor@126.com。
