血清UCP2、TSLP在老年肺炎脓毒症患者中的表达及其预后评估价值

The value of serum UCP2 and TSLP in the early diagnosis and prognosis evaluation of pneumonia complicated by sepsis in the elderly

摘要:

目的 探讨血清UCP2、TSLP在老年肺炎脓毒症患者中的表达，及其在老年肺炎脓毒症早期诊断及预后评估中的价值。方法 选取2017年7月—2019年7月秦皇岛市第一医院收治的103例肺炎合并脓毒症患者为肺炎脓毒症组，根据其28 d生存状态分为生存组（76例）、死亡组（27例）；另取同期该院收治的100例单纯肺炎患者为单纯肺炎组。采用酶联免疫吸附试验检测血清UCP2、TSLP水平，并进行分析。结果 肺炎脓毒症组急性生理学和慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、血清UCP2、TSLP水平高于单纯肺炎组（P <0.05）；肺炎脓毒症组血清UCP2、TSLP水平与APACHE Ⅱ评分呈正相关（r =0.618和0.681，P <0.05）；血清UCP2、TSLP及两者联合诊断肺炎脓毒症的曲线下面积分别为0.861（95% CI：0.809，0.912）、0.846（95% CI：0.792，0.901）和0.914（95% CI：0.873，0.954），血清UCP2、TSLP单独诊断肺炎脓毒症的截断值分别为399.47 ng/ml和249.11 pg/ml，此时对应的敏感性分别为71.8%（95% CI：64.20，82.00）和77.7%（95% CI：81.7，94.5），特异性分别为91.0%（95% CI：75.30，90.60）和81.0%（95% CI：78.8，92.9），联合诊断对应的敏感性为84.5%（95% CI：82.9，95.2），特异性为88.0%（95% CI：84.8，96.5），联合诊断敏感性较高。死亡组血清UCP2、TSLP水平高于生存组（P <0.05）；年龄≥70岁［R=2.017（95% CI：1.268，3.210）］、APACHE Ⅱ评分≥17分［R=2.162（95% CI：1.343，3.481）］、UCP2高水平［R=1.983（95% CI：1.236，3.180）］、TSLP高水平［R=2.416（95% CI：1.533，3.807）］是影响肺炎脓毒症患者预后生存状况的独立危险因素（P <0.05）。结论 肺炎脓毒症患者血清UCP2、TSLP水平较高，其对肺炎脓毒症有一定诊断的价值，是影响患者预后的独立危险因素，可为肺炎脓毒症的诊断及预后评估提供参考。

Abstract:

Objective To explore the value of serum uncoupling protein 2 (UCP2) and thymic stromal lymphopoietin (TSLP) in the early diagnosis and prognosis evaluation of pneumonia complicated by sepsis in the elderly.Methods A total of 103 patients with pneumonia complicated by sepsis in our hospital from July 2017 to July 2019 were selected as pneumonia-complicated-by-sepsis group, and they were subdivided into survival group (76 cases) and death group (27 cases) according to the 28-day survival state. In addition, 100 patients with pneumonia alone in the same period were selected as pneumonia-alone group. The levels of serum UCP2 and TSLP were detected by enzyme-linked immunosorbent assay and compared among groups.Results Compared with those in the pneumonia-alone group, the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, serum UCP2 and TSLP levels in the pneumonia-complicated-by-sepsis group were higher (P < 0.05). The levels of UCP2 and TSLP in pneumonia-complicated-by-sepsis were positively correlated with APACHE Ⅱ (r = 0.618 and 0.681, P < 0.05). The areas under the receiver operating characteristic curves of serum UCP2, TSLP and their combination in the diagnosis of pneumonia complicated by sepsis were 0.861 (95% CI: 0.809, 0.912), 0.846 (95% CI: 0.792, 0.901) and 0.914 (95% CI: 0.873, 0.954), respectively. The optimal cutoff values of serum UCP2 and TSLP alone for the diagnosis of pneumonia complicated by sepsis were 399.47 ng/ml and 249.11 pg/ml, with the corresponding sensitivity being 71.80% (95% CI: 64.20, 82.00) and 77.70% (95% CI:81.7, 94.5), and the specificity being 91.00% (95% CI: 75.30, 90.60) and 81.00% (95% CI: 78.8, 92.9), respectively. However, the sensitivity and specificity of the combined diagnosis were 84.50% (95% CI: 82.9, 95.2) and 88.00% (95% CI: 84.8, 96.5), which were higher than those of the diagnosis with UCP2 or TSLP alone. Compared with those in the survival group, the levels of UCP2 and TSLP in the death group were higher (P < 0.05). The age ≥ 70 years old [R = 2.017 (95% CI: 1.268, 3.210)], APACHE Ⅱ score ≥ 17 [R = 2.162 (95% CI: 1.343, 3.481)], high level of UCP2 [R = 1.983 (95% CI: 1.236, 3.180)], and high level of TSLP [R = 2.416 (95% CI: 1.533, 3.807)] were independent risk factors for the prognosis and survival of patients with pneumonia complicated by sepsis (P < 0.05).Conclusions The levels of serum UCP2 and TSLP in patients with pneumonia complicated by sepsis are high and have a certain diagnostic value for pneumonia complicated by sepsis. Besides, they are independent risk factors for the prognosis and survival of the patients, which may provide clinical reference for the diagnosis and prognosis evaluation of pneumonia complicated by sepsis.