血清Ang-2和PGRN与老年重症肺炎合并呼吸衰竭患者预后的关系

Relationship of serum Ang-2 and PGRN with prognosis of elderly patients with severe pneumonia complicated with respiratory failure treated with nasal high-flow nasal canal humidification oxygen therapy

摘要:

目的 探讨血清血管生成素2（Ang-2）和颗粒蛋白前体（PGRN）与老年重症肺炎合并呼吸衰竭患者预后的关系。方法 前瞻性选取2017年4月—2020年2月天津市第三中心医院收治的合并呼吸衰竭的老年重症肺炎患者302例作为研究对象，根据患者28 d转归情况，将其分为存活组224例和死亡组78例。比较两组患者血清Ang-2和PGRN水平；比较两组患者基线资料；采用Logistic回归分析老年重症肺炎合并呼吸衰竭患者死亡的影响因素；应用受试者工作特征（ROC）曲线评估血清Ang-2和PGRN对预后的预测价值。结果 不同时间点血清Ang-2和PGRN水平有差异（P <0.05）；两组血清Ang-2和PGRN水平有差异（P <0.05），存活组比死亡组低；两组血清Ang-2和PGRN水平变化趋势有差异（P <0.05）。两组患者白细胞计数、淋巴细胞计数、中性粒细胞计数、白细胞介素-10、白细胞介素-6、C反应蛋白、血沉降钙素原及APACHE II评分比较，差异有统计学意义（P <0.05）。Logistic回归分析结果显示：APACHE II评分［O^R=1.379（95% CI：1.094，1.737）］、治疗前血清Ang-2［O^R=2.255（95% CI：1.810，2.808）］、治疗前血清PGRN［O^R=1.493（95% CI：1.206，1.849）］是死亡的危险因素（P <0.05）。根据ROC曲线可得，血清Ang-2诊断临界值为4.10 ng/ml，其对应的敏感性为69.64%（95% CI：0.619，0.748），特异性为61.54%（95% CI：0.543，0.657），ROC曲线下面积（AUC）为0.790（95% CI：0.735，0.846）；血清PGRN诊断的临界值为133.27 g/L，其对应的敏感性为70.54%（95% CI：0.635，0.746），特异性为62.82%（95% CI：0.551，0.677），AUC为0.764（95% CI：0.710，0.818）；在最佳临界切点时，平行联合检测的敏感性为84.82%（95% CI：0.737，0.901），特异性为58.97%（95% CI：0.528，0.632），AUC为0.872（95% CI：0.834，0.911）。结论 血清Ang-2和PGRN与合并呼吸衰竭的老年重症肺炎预后有关，监测其水平对病情诊断、治疗和预后具有重要的临床意义。

关键词:呼吸衰竭;重症肺炎;血管生成素2;颗粒蛋白前体;经鼻高流量氧疗;预后

Abstract:

Objective To study the relationship of serum Ang-2 and PGRN with prognosis of elderly patients with severe pneumonia complicated with respiratory failure treated with nasal high-flow nasal canal humidification oxygen therapy.Methods Totally 302 elderly patients with pneumonia complicated with respiratory failure treated in our hospital from April 2017 to February 2020 were selected as the observation subjects. According to the 28-day prognosis of the patients, they were divided into survival group (n =224) and death group (n =78). The baseline data between the two groups were analyzed by univariate analysis, and logistic regression analysis was used to analyze the statistically significant differences between the two groups. The prognostic value of serum Ang-2 and PGRN was evaluated by the receiver working characteristic curve.Results The expression of serum Ang-2 and PGRN were decreased follow the time after treatment (P < 0.05). Ang-2 and PGRN were lower in the survival group compared with the death group at different time points (P < 0.05), and the gradual decline trend was also different (P < 0.05). There were significant differences in white blood cell count, lymphocyte count, neutrophil count, interleukin-10, interleukin-6, C-reactive protein, procalcitonin, and APACHE II score between the two groups (P <0.05); Logistic regression analysis showed that APACHE II score [O^R = 1.379 (95% CI: 1.094, 1.737)], serum Ang-2 before treatment [O^R = 2.255 (95% CI: 1.810, 2.808)], and serum PGRN before treatment [O^R = 1.493 (95% CI: 1.206, 1.849)] were independent risk factors for poor prognosis (P < 0.05); according to the ROC curve, the critical value of serum Ang-2 diagnosis was 4.10 ng/ml, the corresponding sensitivity was 69.64%, the specificity was 61.54%, and the AUC was 0.790 (95% CI: 0.735, 0.846); the critical value of serum PGRN diagnosis was 133.27 mg/L, the corresponding sensitivity was 70.54%, and the specificity was 62.82%, and the AUC was 0.764 (95% CI: 0.710, 0.818). At the critical tangent point, the sensitivity of parallel joint detection was 84.82%, the specificity was 58.97%, and the AUC was 0.872 (95% CI: 0.834, 0.911), all of them had predictive value.Conclusion The level of serum Ang-2 and PGRN were related to the prognosis, thus monitoring their level had important clinical significance for the diagnosis, treatment, and prognosis of patients with severe pneumonia complicated with respiratory failure.

Key words:respiratory failure;severe pneumonia;angiopoietin-2;progranulins;nasal high-flow nasal canal humidification oxygen therapy;prognosis