社区获得性肺炎患者血清suPAR、sTREM-1、TNF-α、IL-6变化及临床意义

doi:10.3969/j.issn.1004-583X.2021.04.006

摘要/Abstract

摘要：

目的探讨社区获得性肺炎(CAP)患者血清尿激酶型纤溶酶原激活物受体(suPAR)、可溶性髓系细胞触发受体(sTREM-1)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6 (IL-6)的变化及临床意义。方法选取2019年4月-2020年9月在我院治疗的CAP患者100例,其中重症CAP患者50例为重症组,非重症CAP患者50例为非重症组,另选取同期在我院体检的健康人50例作为对照组,采用酶联免疫吸附法检测各组血清suPAR、sTREM-1、TNF-α、IL-6水平;采用肺炎严重度评分(PSI) 及急性生理及慢性健康评估Ⅱ(APACHEⅡ)评分系统评估CAP患者病情严重程度。结果重症组suPAR、sTREM-1、TNF-α、IL-6水平高于非重症组,非重症组上述指标均高于对照组(均P<0.05);重症组PSI、APACHEⅡ评分均高于非重症组(均P<0.01);相关分析显示,suPAR、sTREM-1、TNF-α、IL-6水平与PSI、APACHEⅡ评分存在正相关(r=0.867、0.858、0.723、0.814、0.853、0.846、0.711、0.821,均P<0.01);按重症组患者预后结局分为死亡组(18例)与存活组(32例),死亡组患者suPAR、sTREM-1、IL-6水平高于存活组(均P<0.01);Logistic 回归分析显示,suPAR、sTREM-1、IL-6水平是重症CAP的独立危险因素(P<0.05)。ROC曲线分析显示,suPAR、sTREM-1、IL-6检测重症CAP的AUC分别为0.876、0.831、0.780、0.852(P<0.01)。结论 CAP患者suPAR、sTREM-1、IL-6水平明显升高,且与病情严重程度及预后呈显著正相关,可作为检验重症CAP的参考指标。

关键词: 肺炎, 细胞因子, 酶联免疫吸附测定

Abstract:

Objective To investigate the changes and clinical significance of serum urokinase type plasminogen activator receptor(suPAR), soluble myeloid cells trigger receptor 1 (sTREM-1), tumor necrosis factor-ɑ(TNF-ɑ), interleukin-6(IL-6) in patients with community-acquired pneumonia(CAP). Methods A total of 100 CAP patients in our hospital from Apr 2018 to Sep 2020 were selected, 50 cases of CAP were in severe group and 50 cases of CAP were non-severe group, while 50 healthy people who had physical examination in our hospital during the same period were selected as control group. The serum levels of suPAR, sTREM-1, TNF-α and IL-6 in each group were detected by enzyme-linked immunosorbent assay, the severity of CAP patients were evaluated by Pneumonia Severity Score(PSI), Acute Physiology and Chronic Health Assessment Ⅱ(APACHE Ⅱ) scoring system. Results suPAR, sTREM-1, TNF-α, IL-6 were higher in severe group than those in non-severe group, and the above indexes in non-severe group were higher than those in control group(P<0.05). PSI, APACHEⅡ scores in severe group were higher than those in non-severe group(all P<0.01). Correlation analysis showed that suPAR, sTREM-1, TNF-α, IL-6 levels were positively correlated with PSI score and APACHE Ⅱ score (r=0.867, 0.858, 0.723, 0.853, 0.846, 0.711, 0.821; all P<0.01). By prognosis outcome, the severe group was subdivided into death group (18 cases) and survival group (32 cases), and the levels of suPAR, sTREM-1 and IL-6 in death group were higher than those in survival group (all P<0.01). Logistic regression analysis showed that suPAR, sTREM-1, IL-6 levels were dependent risks for severe CAP (P<0.05). ROC curve analysis showed that AUCs of suPAR, sTREM-1, and IL-6 for the detection of severe CAP were 0.876, 0.831, 0.780, 0.852, respectively (P<0.01). Conclusion suPAR,sTREM-1, IL-6 in CAP patients are significantly increased, and they were positively correlated with the severity and prognosis of the disease, and could be used as reference indicators for the examination of severe CAP.

Key words: pneumonia, cytokines, enzyme-linked immunosorbent assay

中图分类号:

R563.1

郑晓, 郑永华, 胡小燕, 陈占军, 嵇华夏, 钱宝. 社区获得性肺炎患者血清suPAR、sTREM-1、TNF-α、IL-6变化及临床意义[J]. 临床荟萃, 2021, 36(4): 323-327.

Zheng Xiao, Zheng Yonghua, Hu Xiaoyan, Chen Zhanjun, Ji Huaxia, Qian Bao. Changes and clinical significance of serum suPAR, sTREM-1, TNF-α,IL-6 in patients with community-acquired pneumonia[J]. Clinical Focus, 2021, 36(4): 323-327.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.04.006

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I4/323

图/表 7

参考文献 20

[1]	Akhter S, Rizvi N, Bhura S, et al. Management of community acquired pneumonia by family physicians[J]. Pak J Med Sci, 2017,33(4):783-787. doi: 10.12669/pjms.334.12577 pmid: 29067039
[2]	Iasus D, Nfifiez-Ramos JA, Viloria SA, et al. Pharrnacotherapy for community-acquired pneumonia in the elderly[J]. Expert Opin Pharmacother, 2017,18(10):957-964. doi: 10.1080/14656566.2017.1340940 URL
[3]	Amalakuhan B, Eehevarria KL, Restrepo MI. Managing community acquired pneumonia in the elderly-the next generation of pharmacotherapy on the horizon[J]. Expert Opin Pharmaeo, 2017,18(11):1039-1048.
[4]	张林娇, 张明, 于思筠. HMGB1 水平与重症肺炎伴ARDS 的相关性分析[J]. 实验与检验医学, 2019,37(2):276-278.
[5]	孙海伟, 刘励军, 马丽梅, 等. B型尿钠肽和可溶性尿激酶型纤溶酶原激活物受体预测重症监护病房患者血流感染的价值[J]. 中华急诊医学杂志, 2019,28(3):356-360.
[6]	KirkegaarD-Klitbo DM, Langkilde A, Mejer N, et al. Soluble urokinase plasminogen activator receptor is a predictor of incident non-AIDS comorbidity and all-cause mortality in human immunodeficiency virus type 1 infection[J]. J Infect Dis, 2017,216(7):819-823. doi: 10.1093/infdis/jix266 URL
[7]	李景周, 陈培莉, 王卫民等. 血清sTREM-1和CRP/Alb比值监测在糖尿病酮症酸中毒合并感染中的应用价值[J]. 广东医学, 2020,41(10):1032-1036.
[8]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会等. 成人社区获得性肺炎基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2019,18(2):117-126.
[9]	Ahuna VS, Aliaga VR, Maguifia JL, et al. Risk of comnmnity-acquired pneumonia in olderly adults with sarcopenia of a hospital from Callao,Peru 2010-2015[J]. Arch Gerontol Geriatr, 2019,82:100-105. doi: 10.1016/j.archger.2019.01.008 URL
[10]	Koller L, Stojkovic S, Richter B, et al. Soluble urokinase-type plasminogen activator receptor improves risk prediction in patients with chronic heart failure[J]. JACC Heart Fail, 2017,5(4):268-277. doi: 10.1016/j.jchf.2016.12.008 URL
[11]	闵安, 项和平, 李贺, 等. 可溶性尿激酶型纤溶酶原激活物受体在预测结肠破裂术后脓毒症及评估预后的作用[J]. 创伤外科杂志, 2018,20(2):92-96.
[12]	孙珊, 宋爱琴. 新型生物标志物在脓毒症诊断、治疗和预后中的潜在价值[J]. 中国现代医学杂志, 2020,30(5):66-70.
[13]	周帆, 黄云峰. 可溶性尿激酶型纤溶酶原激活物受体联合降钙素原检测在呼吸机相关性肺炎早期诊断及预后判断中的价值[J]. 实用临床医药杂志, 2019,23(7):64-67.
[14]	邹芳, 王金龙, 杜彪, 等. 重症肺炎患者血清SuPAR、RAGE、PCT水平及临床意义[J]. 解放军医药杂志, 2020,32(8):57-61.
[15]	孙印, 韦海燕, 何士杰等. 重症肺炎患者血清suPAR、sTREM-1水平变化及意义[J]. 山东医药, 2017,57(22):59-60.
[16]	陈晓珊. 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[J]. 标记免疫分析与临床, 2020,27(1):136-141.
[17]	黄朋, 方恋, 陈波, 等. 重症肺炎患者血清降钙素原、C-反应蛋白、D二聚体及炎症因子水平变化及其临床意义[J]. 安徽医药, 2018,22(3):478-482.
[18]	冯旭, 丁锋, 郭宏杰, 等. APACHE评分联合TNF-α、IL-10、IL-1β水平测定对老年重症肺炎患者预后结局的评估价值[J]. 中国老年学杂志, 2020,40(8):1630-1633.
[19]	高淑平, 温旺荣, 谭艳玲, 等. 慢性阻塞性肺疾病急性加重期伴肺炎患者血清IL-6 、HPT 、SAA 的检测价值分析[J]. 国际检验医学杂志, 2018,39(12):1479-1481.
[20]	Yasuda H, Ikeda T, Hamaguchi Y, et al. Clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia:The relation between the disease activity and the serum interleukin-6 level[J]. J Dermatol, 2017,44(10):1164-1167. doi: 10.1111/jde.2017.44.issue-10 URL

组别	例数	性别[例(%)]		年龄(岁)	BMI(kg/m²)	吸烟史[例(%)]
组别	例数	男	女	年龄(岁)	BMI(kg/m²)	吸烟史[例(%)]
重症组	50	31(62.0)	19(38.0)	63.52±12.37	22.46±2.49	26(52.0)
非重症组	50	28(56.0)	22(44.0)	60.72±14.82	22.83±2.48	24(48.0)
对照组	50	29(58.0)	21(42.0)	62.82±12.25	23.04±2.81	21(42.0)
F/χ²值		0.792		1.347	0.728	0.882
P值		0.512		0.284	0.492	0.624

组别	例数	性别[例(%)]		年龄(岁)	BMI(kg/m²)	吸烟史[例(%)]
组别	例数	男	女	年龄(岁)	BMI(kg/m²)	吸烟史[例(%)]
重症组	50	31(62.0)	19(38.0)	63.52±12.37	22.46±2.49	26(52.0)
非重症组	50	28(56.0)	22(44.0)	60.72±14.82	22.83±2.48	24(48.0)
对照组	50	29(58.0)	21(42.0)	62.82±12.25	23.04±2.81	21(42.0)
F/χ²值		0.792		1.347	0.728	0.882
P值		0.512		0.284	0.492	0.624

组别	例数	suPAR(ng/ml)	sTREM-1(pg/ml)	TNF-α(ng/ml)	IL-6(pg/ml)
重症组	50	11.48±2.48	71.67±12.87	46.28±9.21	88.47±21.64
非重症组	50	8.27±2.24	55.22±11.82	41.42±10.58	45.22±18.43
对照组	50	5.12±1.94	29.47±8.79	4.72±1.28	6.27±2.48
F值		123.63	92.95	156.53	184.52
P值		<0.01	<0.01	<0.01	<0.01

组别	例数	suPAR(ng/ml)	sTREM-1(pg/ml)	TNF-α(ng/ml)	IL-6(pg/ml)
重症组	50	11.48±2.48	71.67±12.87	46.28±9.21	88.47±21.64
非重症组	50	8.27±2.24	55.22±11.82	41.42±10.58	45.22±18.43
对照组	50	5.12±1.94	29.47±8.79	4.72±1.28	6.27±2.48
F值		123.63	92.95	156.53	184.52
P值		<0.01	<0.01	<0.01	<0.01

组别	例数	suPAR(ng/ml)	sTREM-1(pg/ml)	TNF-α(ng/ml)	IL-6(pg/ml)
死亡组	18	16.42±2.94	86.89±14.29	50.40±11.24	139.35±23.53
存活组	32	8.84±2.45	57.27±13.27	44.14±10.54	47.82±20.27
t值		9.767	7.371	1.969	14.462
P值		<0.01	<0.01	0.055	<0.01