摘要
目的探讨肺炎继发脓毒症患者血清碱性亮氨酸拉链ATF样转录因子(BATF),补体C3A受体1(C3AR1)水平与病情严重程度的关系及预后评估价值。方法选取2019年3月至2021年3月诊治的112例肺炎继发脓毒症患者为脓毒症组,根据28 d预后情况分为生存组(77例)和死亡组(35例),以同期诊治的60例无脓毒症肺炎患者为肺炎对照组,60例健康体检的健康人为健康对照组。应用酶联免疫吸附试验检测血清BATF、C3AR1水平。比较不同预后肺炎继发脓毒症患者临床资料及血清BATF、C3AR1水平。Spearman秩相关分析血清BATF、C3AR1水平与序贯器官衰竭评分(SOFA)的相关性。多因素Logistic回归分析影响肺炎继发脓毒症患者28 d死亡预后的因素。受试者工作特征曲线分析各指标对肺炎继发脓毒症患者28 d死亡预后的预测价值。结果脓毒症组患者血清BATF[(2.26±0.41)μg/L],C3AR1[(40.41±7.08)mg/L,]水平高于肺炎对照组[(1.02±0.29)μg/L,(31.84±6.12)mg/L]和健康对照组[(0.53±0.12)μg/L,(23.79±6.39)mg/L],差异有统计学意义(t=10.199~57.009,均P<0.05)。死亡组患者血清BATF[(2.96±0.48)μg/L vs.(1.94±0.36)μg/L],C3AR1[(44.26±7.35)mg/L vs.(38.66±6.78)mg/L],PCT,SOFA评分高于生存组,差异有统计学意义(t=3.946~35.388,均P<0.05)。PCT、BATF、C3AR1和SOFA评分升高是影响肺炎继发脓毒症患者28 d死亡预后的独立危险因素。血清PCT、BATF、C3AR1和SOFA评分联合对肺炎继发脓毒症患者28日死亡预后预测的曲线下面积为0.945,大于血清PCT、BATF、C3AR1和SOFA单项指标0.836、0.830、0.772、0.896,差异有统计学意义(Z=8.417,8.366,9.050,2.384,均P<0.05)。结论肺炎继发脓毒症患者血清BATF、C3AR1水平升高,两者疾病严重程度有关,血清PCT、BATF、C3AR1和SOFA评分联合对肺炎继发脓毒症患者预后具有较高的预测效能。
Objective To investigate the correlation of serum basic leucine zipper ATF-like transcription factor(BATF),and complement C3A receptor 1(C3AR1)with the severity and prognosis of patients with sepsis secondary to pneumonia.Methods From March 2019 to March 2021,112 patients with sepsis secondary to pneumonia diagnosed and treated in our hospital were selected as the sepsis group.They were divided into survival group(n=77)and death group(n=35)according to the 28-day prognosis.A total of 60 patients with non-sepsis pneumonia diagnosed and treated in the same period were selected as the pneumonia control group,and 60 healthy people receiving the physical examination were selected as the health control group.Serum levels of BATF and C3AR1 were detected by enzyme-linked immunosorbent assay(ELISA).The clinical data and serum levels of BATF and C3AR1 in patients with sepsis secondary to pneumonia experiencing different statues of prognosis were compared.Spearman rank correlation analysis was used to analyze the correlation of serum BATF and C3AR1 levels with the sequential organ failure score(SOFA).Multivariate logistic regression analysis was performed to identify independent risk factors for the 28-day mortality of patients with sepsis secondary to pneumonia,and their predictive value was assessed by plotting the receiver operating characteristic(ROC)curves.Results Serum BATF([2.26±0.41]μg/L vs[1.02±0.29]μg/L vs[0.53±0.12]μg/L)and C3AR1 levels([40.41±7.08]mg/L vs[31.84±6.12]mg/L vs[23.79±6.39]mg/L)were significantly higher in the sepsis group than those in the pneumonia control group and healthy control group(t=10.199-57.009,both P<0.05).Serum BATF([2.96±0.48]μg/L vs[1.94±0.36]μg/L),C3AR1([44.26±7.35]mg/L vs[38.66±6.78]mg/L),serum procalcitonin(PCT)and SOFA scores were all significantly higher in the death group than those in the survival group(t=3.946-35.388,all P<0.05).Elevated PCT,BATF,C3AR1 and SOFA scores were independent risk factors affecting the prognosis of 28-day mortality in patients with sepsis secondary to pneumonia.The area under the curve(AUC)of the combination detection of serum PCT,BATF and C3AR1 and SOFA scores on the 28-day mortality of patients with sepsis secondary to pneumonia was 0.945,which was significantly larger than that of a single detection(AUC=0.836,0.830,0.772 and 0.896,respectively;Z=8.417,8.366,9.050 and 2.384,respectively;all P<0.05).Conclusion Serum BATF and C3AR1 levels increase in patients with sepsis secondary to pneumonia,which are correlated with the severity.The combination detection of serum PCT,BATF and C3AR1 and SOFA scores has a high predictive value in the prognosis of patients with sepsis secondary to pneumonia.
作者
布仁特古斯
马媛媛
照娜
乌日古玛拉
图门乌力吉
Burentegusi;MA Yuanyuan;ZHAO Na(College of Mongolian Medicine,Inner Mongolia Medical University,Inner Mongolia,Hohhot 010010,China;不详)
出处
《河北医药》
CAS
2023年第19期2911-2915,共5页
Hebei Medical Journal
基金
内蒙古自治区医疗卫生科技计划项目(编号:201901334)。
