目的：分析血清白介素-6（interleukin,IL）、D-二聚体（D-dimer,D-D）、降钙素原（procalcitonin,PCT）在重症肺炎机械通气患者中的临床表达意义及预后评估中的价值。方法：使用回顾性分析法,将2022年12月—2024年10月我院接收的280例重症肺炎行机械通气患者纳入病例组,另择取90例健康体检者作为健康组,采用COX比例风险回归模型患者预后的单因素和多因素分析。通过随访获取患者的预后信息,采用受试者工作特征曲线（receiver operating characteristic curve,ROC）分析血清IL-6、D-D、PCT联合检测对重症肺炎机械通气患者死亡的预测价值。结果：病例组患者血清IL-6、D-D、PCT表达水平明显高于健康组。随访时间为13（7,14）d,280例重症肺炎机械通气患者中死亡例30例（10.71）%,存活250例（89.29）%,中位OS时间9（7,11）d。单因素分析结果显示,年龄、IL-6、D-D、PCT、氧合指数（PaO2/FiO2）均与重症肺炎机械通气患者不良预后有关。COX多因素回归分析结果显示,年龄、IL-6、D-D、PCT均是重症肺炎机械通气患者不良预后的独立危险因素,氧合指数（PaO2/FiO2）是其保护因素。ROC曲线显示,血清IL-6、D-D、PCT单项指标预测重症肺炎机械通气患者不良预后的AUC、敏感度、特异度分别为（0.738、0.903、0.839;76.7%、86.7%、83.3%;70.4%、74.0%、72.8%）,均低于三项指标联合预测的AUC、敏感度（0.955、96.7%、89.2%）。结论：COX比例风险模型分析显示,血清IL-6、D-D、PCT是重症肺炎机械通气患者预后评估指标。血清IL-6、D-D、PCT在重症肺炎机械通气患者中表达升高,与病情严重程度密切相关,联合检测对预后评估具有重要价值。
Abstract
Objective To analyze the clinical expression significance of serum interleukin-6 (IL-6), D-dimer (D-D) and procalcitonin (PCT) in mechanical ventilation patients with severe pneumonia and the value of prognosis evaluation. Methods The subjects of this study were 280 patients with mechanical ventilation and severe pneumonia who were admitted to the hospital between December 2022 and October 2024, as well as 90 healthy physical examination patients. The Kaplan-Meier method and the Cox proportional risk regression model were used to analyze patient prognosis both univariately and multivariately. Patients' prognostic information was acquired through follow-up, and the predictive value of serum IL-6, D-D, and PCT in the combination detection of mechanical ventilation in patients with severe pneumonia was studied using a receiver operating characteristic curve (ROC). Results The serum levels of IL-6, D-D, and PCT in the case group were higher than those in the healthy group. The follow-up time was 13 (7, 14) days, with 30 deaths (10.71%) among 280 patients with severe pneumonia on mechanical ventilation, and 250 survivors (89.29%), with a median overall survival (OS) time of 9 (7, 11) days. Univariate analysis results indicated that age, IL-6, D-D, PCT, and PaO2/FiO2 were all associated with poor prognosis in patients with severe pneumonia on mechanical ventilation. The results of COX multivariate regression analysis showed that age, IL-6, D-D, and PCT were independent risk factors for poor prognosis in patients with severe pneumonia on mechanical ventilation, while PaO2/FiO2 was a protective factor. The ROC curve indicated that the AUC, sensitivity, and specificity for predicting poor prognosis in patients with severe pneumonia on mechanical ventilation based on single serum indicators of IL-6, D-D, and PCT were (0.738, 0.903, 0.839; 76.7%, 86.7%, 83.3%; 70.4%, 74.0%, 72.8%), all of which were lower than those obtained by combined prediction of the three indicators with AUC and sensitivity (0.955, 96.7%, 89.2%). Conclusion Cox proportional risk model analysis showed that serum IL-6, D-D and PCT were prognostic indicators for patients with severe pneumonia. The expression of serum IL-6, D-D and PCT is increased in patients with severe pneumonia with mechanical ventilation, which is closely related to the severity of the disease, and the combined detection is of great value in the prognosis assessment.
关键词
重症肺炎 /
机械通气 /
白细胞介素-6 /
D-二聚体 /
降钙素原 /
预后评估价值
Key words
severe pneumonia /
mechanical ventilation /
interleukin-6 /
D-dimer /
procalcitonin /
prognostic value
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基金
岳阳市中心医院重点课题“免疫功能抑制并重症肺炎患者的临床特征分析及宏基因组二代基因测序的病原学诊断价值”（YYSZXYN2022015）; 江苏省卫生健康委科研项目“基于新型细胞富集技术与多参数智能评测系统的食管癌诊疗体系构建研究”（ZD2021038）
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