Value of soluble fms-like tyrosine kinase 1 for prognosis of severe pneumonia
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摘要: 目的:分析可溶型Fms样酪氨酸激酶1(sFLT-1)在重症肺炎中的预测价值及其与急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分的相关性。方法:回顾性分析2017-01—2019-01收治的76例重症肺炎患者(Ⅰ组),另选择同期65例普通肺炎患者(II组),非肺炎住院患者52例(III组)。比较3组患者临床基本资料和入院后不同时间血浆sFLT-1含量的差异,并比较Ⅰ组入院后4周存活(存活组,64例)与死亡患者(死亡组,12例)入院1 d内APACHEⅡ评分、血浆sFLT-1含量的差异。通过绘制受试者工作特征(ROC)曲线评价血浆sFLT-1在评估重症肺炎诊断与预后中的预测价值,采用Pearson相关性分析血浆sFLT-1含量与Ⅰ组患者APACHEⅡ评分的相关性。结果:3组患者入院1 d内APACHEⅡ评分的比较,差异有统计学意义(P＜0.05)。入院后不同时间血浆sFLT-1含量的比较,差异有统计学意义(P＜0.05)。Ⅰ组死亡患者入院1 d内APACHEⅡ评分和血浆sFLT-1含量较存活患者均显著升高(P＜0.05)。sFLT-1诊断重症肺炎的敏感度和特异度分别为85.53%、77.50%,sFLT-1预测重症肺炎预后评估(入院后4周死亡)的敏感度和特异度分别为75.00%、82.81%,ROC曲线下面积分别为0.84(95%CI:0.75~0.95,P＜0.05)、0.79(95%CI:0.68~0.91,P＜0.05。Pearson相关性分析发现,Ⅰ组患者血浆sFLT-1含量与APACHEⅡ评分存在正相关关系(r=0.72,P＜0.05)。结论:血浆sFLT-1含量与APACHEⅡ评分密切相关,通过监测血浆sFLT-1含量可用于诊断重症肺炎和评估患者的预后状况,有良好的预测价值。
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关键词:
- 重症肺炎 /
- 可溶型Fms样酪氨酸激酶1 /
- 急性生理与慢性健康评分Ⅱ /
- 预测价值
Abstract: Objective: To analyze the predictive value of soluble fms-like tyrosine kinase 1 (sFLT-1) for severe pneumonia and its relationship with acute physiology and chronic health evaluation II (APACHE Ⅱ) scores.Method: A retrospective analysis was made of 76 patients with severe pneumonia (group I) admitted to our hospital from January 2017 to January 2019.Another 65 patients with common pneumonia were selected as group II,and 52 healthy people without pneumonia were selected as group III.Clinical basic data and plasma sFLT-1 at different time after admission of three groups of patients were compared.APACHE Ⅱ scores and plasma sFLT-1 within 1 d after admission of survival (survival group) and death (death group) at 4 weeks after admission patients admitted to hospital were compared.The predictive value of plasma sFLT-1 in the diagnosis and prognosis of severe pneumonia was evaluated by the receiver-operating characteristic (ROC) curve.The correlation between plasma sFLT-1 and APACHE Ⅱ scores in the patients with severe pneumonia (groupⅠ) was analyzed by Pearson correlation analysis.Result: There were significant differences in APACHE Ⅱ scores among the three groups admitted to hospital with in 1 day (P=0.01). There were significant differences in plasma sFLT-1 levels among the three groups at different time after admission (P＜0.05). The APACHE Ⅱscore and plasma sFLT-1 in dead patients were significantly higher than those of survived patients admitted to hospital within 1 day in groupⅠ (P＜0.05). The sensitivity and specificity of sFLT-1 in the diagnosis of severe pneumonia were 85.53% and 77.50%,respectively.The sensitivity and specificity of sFLT-1 in the prognosis assessment of severe pneumonia (death 4 weeks after admission) were 75.00% and 82.81%,respectively.The area under the ROC curve was 0.84 (95%CI:0.75-0.95,P＜0.05) and 0.79 (95%CI:0.68-0.91,P＜0.05). Pearson correlation analysis found that plasma sFLT-1 levels was positive correlated with APACHE Ⅱ scores in groupⅠ (r=0.72,P＜0.05). Conclusion: Plasma sFLT-1 content was closely related to the APACHE Ⅱ scores.Monitoring the content of plasma sFLT-1 could be used to diagnose and evaluate the prognosis of patients with severe pneumonia,which might have a good predictive value. -
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[1] Jonnalagadda S,Rodríguez O,Estrella B,et al.Etiology of severe pneumonia in Ecuadorian children[J].PLoS One,2017,12:e0171687.
[2] 高延秋,张根生,李双凤,等.血管外肺水指数联合血管内皮生长因子受体1对重症肺炎ARDS合并感染性休克患者预后的评估[J].中华急诊医学杂志,2018,27(12):1381-1387.
[3] 中国医师协会急诊医师分会.中国急诊重症肺炎临床实践专家共识[J].中国急救医学,2016,36(2):97-107.
[4] Gupta S,Mishra M.Acute Physiology and Chronic Health Evaluation II score of ≥15:A risk factor for sepsis-induced critical illness polyneuropathy[J].Neurol India,2016,64:640-645.
[5] 崔海涛,秦洪伟,PCT、CRP联合血清淀粉样蛋白A在细菌性肺炎与病毒性肺炎中的应用[J].临床血液学杂志,2018,31(8):603-606.
[6] Yang F.Oxygen-driving and atomized mucosolvan inhalation combined with holistic nursing in the treatment of children severe bronchial pneumonia[J].Pak J Pharm Sci,2015,28:1477-1480.
[7] Aota T,Matsumoto T,Suzuki K,et al.Antithrombin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation:an observational nationwide study:comment[J].J Thromb Haemost,2015,13:679-680.
[8] Akagi T,Nagata N,Miyazaki H,et al.Procalcitonin is not an independent predictor of 30-day mortality,albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital[J].BMC Geriatr,2019,19:3.
[9] Liu GB,Cui XQ,Wang ZB,et al.Detection of serum procalcitonin and hypersensitive C-reactive protein in patients with pneumonia and sepsis[J].J Biol Regul Homeost Agents,2018,32:1165-1169.
[10] Honda T,Uehara T,Matsumoto G,et al.Neutrophil left shift and white blood cell count as markers of bacterial infection[J].Clin Chim Acta,2016,457:46-53.
[11] Williams DJ,Hall M,Auger KA,et al.Association of white blood cell count and C-reactive protein with outcomes in children hospitalized for community-acquired pneumonia[J].Pediatr Infect Dis J,2015,34:792-793.
[12] Yang KY,Liu KT,Chen YC,et al.Plasma soluble vascular endothelial growth factor receptor-1 levels predict outcomes of pneumonia-related septic shock patients:a prospective observational study[J].Crit Care,2011,15:R11.
[13] Erturk I,Yesildal F,Acar R,et al.Vascular endothelial growth factor and soluble vascular endothelial growth factor receptor-1 in patients with end-stage renal disease.Associations with laboratory findings,comorbidities,and medications[J].Saudi Med J,2018,39:586-591.
[14] 李瑞萍,宋伟.血浆sTREM-1、sFLT-1及APACHEⅡ评分对重症肺炎患者预后评估价值[J].国际呼吸杂志,2018,38(13):968-971.
[15] 高延秋,张华,李双凤,等.血浆可溶性血管内皮生长因子受体1在重症肺炎患者中的诊断与预测价值[J].郑州大学学报(医学版),2017,52(1):63-67.
[16] 陈红梅,陈雪梅.APACHE评分联合血乳酸清除率在评估老年重症肺炎患者预后中的价值[J].临床肺科杂志,2018,23(7):1271-1274.
[17] 刘思齐,王琦,向华,等.乳酸联合APACHEⅡ评分系统对老年社区获得性肺炎患者预后的评估价值[J].空军医学杂志,2018,34(2):138-141.
[18] 张越新,张玲,郭贤庆,等.PCT CRP血乳酸APACHE Ⅱ SOFA评分在脓毒症患者疾病严重程度及预后评估中的价值研究[J].中国急救医学,2017,37(12):1109-1114.
[19] 江浩,郑贸根,朱超男,等.APACHEⅡ、ISS、SOFA评分对创伤继发ARDS严重程度及预后的预测价值比较[J].临床肺科杂志,2018,23(11):2074-2078.
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