[1]曲春雨,卢灵灵,王素魏,等.血清白细胞介素-10和中性粒细胞明胶酶相关脂质运载蛋白水平对纤维支气管镜吸痰灌洗治疗重症肺炎患者预后的预测价值[J].新乡医学院学报,2022,39(10):978-982.[doi:10.7683/xxyxyxb.2022.10.015]
　QU Chunyu,LU Lingling,WANG Suwei,et al.Predictive value of serum interleukin-10 and neutrophil gelatinase associated lipocalin levels on the prognosis of patients with severe pneumonia treated with sputum aspiration and lavage by fiberoptic bronchoscopy[J].Journal of Xinxiang Medical University,2022,39(10):978-982.[doi:10.7683/xxyxyxb.2022.10.015]
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血清白细胞介素-10和中性粒细胞明胶酶相关脂质运载蛋白水平对纤维支气管镜吸痰灌洗治疗重症肺炎患者预后的预测价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年10
页码:
978-982
栏目:
临床研究
出版日期:
2022-10-05

文章信息/Info

Title:
Predictive value of serum interleukin-10 and neutrophil gelatinase associated lipocalin levels on the prognosis of patients with severe pneumonia treated with sputum aspiration and lavage by fiberoptic bronchoscopy
作者:
曲春雨; 卢灵灵; 王素魏; 常平
（南阳市中医院重症医学科，河南　南阳　473000）
Author(s):
QU Chunyu; LU Lingling; WANG Suwei; CHANG Ping
(Department of Critical Care Medicine,Nanyang Hospital of Traditional Chinese Medicine,Nanyang 473000,Henan Province,China)
关键词:
重症肺炎; 纤维支气管镜; 吸痰; 灌洗; 白细胞介素-10; 中性粒细胞明胶酶相关脂质运载蛋白
Keywords:
severe pneumonia; fiberoptic bronchoscope; sputum suction; lavage; interleukin-10; neutrophil gelatinase associated lipocalin
分类号:
R563.1
DOI:
10.7683/xxyxyxb.2022.10.015
文献标志码:
A
摘要:
目的　探讨血清白细胞介素-10（IL-10）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平对纤维支气管镜吸痰灌洗治疗重症肺炎患者预后的预测价值。方法　选择2018年7月到2021年1月南阳市中医院收治的89例重症肺炎患者为研究对象，患者均在常规治疗基础上实施纤维支气管镜吸痰灌洗治疗，连续治疗7 d后评估患者预后，根据预后将患者分为预后不良组与预后良好组。比较2组患者年龄、性别、入院时急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）及血清IL-10、NGAL水平，采用logistic回归分析重症肺炎患者经纤维支气管镜吸痰灌洗治疗预后的相关因素，应用受试者操作特征（ROC）曲线分析入院时血清IL-10、NGAL水平对重症肺炎患者经纤维支气管镜吸痰灌洗治疗预后的评估价值，绘制决策曲线分析重症肺炎患者入院时血清IL-10、NGAL水平单独或联合评估纤维支气管镜吸痰灌洗治疗预后的净受益率。结果　89例重症肺炎患者中，38例（42.70%）痊愈、19例（21.35%）显效、8例（8.99%）有效、24例（26.97%）无效；预后良好患者65例，预后不良患者24例，预后不良发生率为26.97%。预后不良组与预后良好组患者性别、年龄和入院时收缩压、舒张压比较差异无统计学意义（P>0.05）；预后不良组患者入院时APACHEⅡ评分显著高于预后良好组（P<0.05）；预后不良组患者IL-10水平显著低于预后良好组，NGAL显著高于预后良好组（P<0.05）。Logistic回归分析结果显示，入院时APACHEⅡ评分与重症肺炎患者经纤维支气管镜吸痰灌洗治疗预后无关（OR=1.212，P>0.05）；高IL-10水平是重症肺炎患者经纤维支气管镜吸痰灌洗治疗预后不良的保护因素（OR=0.623，P<0.05），高NGAL水平是重症肺炎患者经纤维支气管镜吸痰灌洗治疗预后不良的危险因素（OR=1.125，P<0.05）。ROC曲线分析结果显示，入院时血清IL-10、NGAL水平单独及联合预测重症肺炎患者经纤维支气管镜吸痰灌洗治疗预后不良的AUC分别为0.815、0.826、0.868，特异度分别为0.750、0.708、0.708，灵敏度分别为0.785、0.831、0.862。决策曲线分析结果显示，在阈值0.1~0.7范围内，重症肺炎患者入院时血清IL-10与NGAL联合评估纤维支气管镜吸痰灌洗治疗不良预后的净受益率优于单独IL-10、NGAL，且在高风险阈值0.0~1.0内的净受益率始终大于0，净受益率最大值为0.270。结论　重症肺炎患者入院时血清IL-10、NGAL水平与纤维支气管镜吸痰灌洗治疗预后相关，入院时血清IL-10、NGAL水平单独或联合检测对纤维支气管镜吸痰灌洗治疗的不良预后均有一定预测价值，且血清IL-10与NGAL水平联合评估获得的净受益率更高。
Abstract:
Objective　To investigate the predictive value of serum interleukin-10 (IL-10) and neutrophil gelatinase associated lipocalin (NGAL) levels on the prognosis of patients with severe pneumonia treated with sputum aspiration and lavage by fiberoptic bronchoscopy.Methods　A total of 89 patients with severe pneumonia admitted to Nanyang Hospital of Traditional Chinese Medicine from July 2018 to January 2021 were selected as the study subjects.All patients were treated with sputum aspiration and lavage by fiberoptic bronchoscopy on the basis of routine treatment.The prognosis of patients was evaluated after 7 consecutive days of treatment.According to the prognosis,the patients were divided into poor prognosis group and good prognosis group.The age,sex,acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ) and serum IL-10 and NGAL levels of patients at admission between the two groups were compared,the relevant factors of the prognosis of patients with severe pneumonia after sputum aspiration and lavage by fiberoptic bronchoscopy was analyzed by logistic regression,and the predictive value of serum IL-10 and NGAL levels at admission on the prognosis of patients with severe pneumonia after sputum aspiration and lavage by fiberoptic bronchoscopy was analyzed by receiver operator characteristic(ROC) curve,the net benefit rate of serum IL-10 and NGAL levels at admission alone and in combination in evaluation on the prognosis of sputum aspiration and lavage treatment with fiberoptic bronchoscopy was analyzed by the decision curve.Results　Among the 89 patients with severe pneumonia,38 cases (42.70%) were cured,19 cases (21.35%) were significantly effective,8 cases (8.99%) were effective,and 24 cases (26.97%) were ineffective;there were 65 patients with good prognosis and 24 patients with poor prognosis,the incidence of poor prognosis was 26.97%.There was no significant difference in gender,age,systolic blood pressure and diastolic blood pressure at admission between poor prognosis group and good prognosis group (P>0.05);APACHE Ⅱ score of patients in the poor prognosis group was significantly higher than that in the good prognosis group (P<0.05).The level of serum IL-10 of patients in the poor prognosis group was significantly lower than that in the good prognosis group,and the level of serum NGAL was significantly higher than that in the good prognosis group (P<0.05).The results of logistic regression analysis showed that APACHEⅡ score at admission was not related to the prognosis of patients with severe pneumonia after sputum aspiration and lavage by fiberoptic bronchoscopy (OR=1.212,P>0.05);the high level of serum IL-10 was a protective factor for the poor prognosis of patients with severe pneumonia treated with sputum aspiration and lavage by fiberoptic bronchoscopy (OR=0.623,P<0.05),and the high level of serum NGAL was a risk factor for the poor prognosis of patients with severe pneumonia treated with sputum aspiration and lavage by fiberoptic bronchoscopy (OR=1.125,P<0.05).ROC curve analysis showed that the AUC of serum IL-10 and NGAL levels at admission and their combination in predicting the poor prognosis of patients with severe pneumonia after treatment of sputum aspiration and lavage by fiberoptic bronchoscopy was 0.815,0.826 and 0.868,respectively;the specificity was 0.750,0.708 and 0.708,respectively,and the sensitivity was 0.785,0.831 and 0.862,respectively.The results of decision curve analysis showed that the net benefit rate of serum IL-10 and NGAL at admission in combination to evaluate the poor prognosis of sputum aspiration and lavage by fiberoptic bronchoscopy treatment in patients with severe pneumonia was better than that of IL-10 and NGAL alone within the threshold value of 0.1-0.7.Moreover,within the high-risk threshold value of 0.0-1.0,the net benefit rate was always greater than 0,the maximum value of the net benefit rate was 0.270.Conclusion　The levels of serum IL-10 and NGAL of patients with severe pneumonia at admission are related to the prognosis of sputum aspiration and lavage by fiberoptic bronchoscopy.The detection of serum IL-10 and NGAL levels alone or in combination at admission has certain predictive value for the poor prognosis of sputum aspiration and lavage by fiberoptic bronchoscopy,and the net benefit rate obtained by the combined assessment of serum IL-10 and NGAL level is higher.

参考文献/References:

［1］　付黎明,朱平,李春燕.纤维支气管镜吸痰灌洗联合机械排痰治疗吸入性肺炎并发呼吸衰竭疗效观察［J］.新乡医学院学报,2018,35(7):612-615.
FU L M,ZHU P,LI C Y.Effect of sputum ruction and lavage by fiexible bronchofiberscope combined with mechanical expectoration in the treatment of patients with aspiration pneumonia complicated with respiratory failure［J］.J Xinxiang Med Univ,2018,35 (7):612- 615.
［2］　WU L,LIU B.The clinical effect of a bronchofiberscope in treating severe ventilator-associated pneumonia［J］.Am J Transl Res,2021,13(6):6966-6972.
［3］　KUMAR V.Pulmonary innate immune response determines the outcome of inflammation during pneumonia and sepsis-associated acute lung injury［J］.Front Immunol,2020,11:1722.
［4］　周斌武,黄菲,张伟,等.RORγt mRNA、NF-κB、IL-10的水平变化与老年肺炎患者严重程度的关系及诊断价值研究［J］.标记免疫分析与临床,2019,26(11):1916-1920.
ZHOU B W,HUANG F,ZHANG W,et al.The study on the relationships between changes of RORγt mRNA,NF-κB,IL10 levels and the severity of senile pneumonia and their diagnostic values［J］.Labeled Immunoassays Clin Med,2019,26 (11):1916-1920.
［5］　WANG Y,JIA M,YAN X,et al.Increased neutrophil gelatinase-associated lipocalin (NGAL) promotes airway remodelling in chronic obstructive pulmonary disease［J］.Clin Sci (Lond),2017,131(11):1147-1159.
［6］　FOUAD T R,ABDELSAMEEA E,ELSABAAWY M,et al.Urinary neutrophil gelatinase- associated lipocalin for diagnosis of spontaneous bacterial peritonitis［J］.Trop Doct,2019,49(3):189-192.
［7］　北京协和医院.北京协和医院诊疗常规:呼吸内科诊疗常规［M］.2版.北京:人民卫生出版社,2012:180-190.
PEKING UNION MEDICAL COLLEGE HOSPITAL.Diagnosis and treatment routine of Peking Union Medical College Hospital:diagnosis and treatment routine of respiratory department［M］.2nd edition.Beijing:People′s Medical Publishing House,2012:180-190.
［8］　GUNASEKARAN S,MAHADEVAIAH S.Healthcare-associated infection in intensive care units:overall analysis of patient criticality by acute physiology and chronic health evaluation IV scoring and pathogenic characteristics［J］.Indian J Crit Care Med,2020,24(4):252-257.
［9］　闫登峰,朱春雨,胡淼.血必净联合纤维支气管镜吸痰灌洗治疗重症肺炎的疗效及对血清炎性因子水平的影响［J］.安徽医药,2020,24(4):759-762.
YAN D F,ZHU C Y,HU M.Xuebijing combined with sputum aspiration and bronchoalveolar lavage via fiberoptic bronchoscope in treatment of severe pneumonia and the effects on serum inflammatory cytokines level［J］.Anhui Med Pharmaceut J,2020,24 (4):759-762.
［10］　葛娟,尹栗.PCT、白细胞参数、IL-6和IL-10在早期鉴别上叶肺炎与上叶肺结核中的作用［J］.中国热带医学,2018,18(6):617-618,630.
GE J,YIN L.The role of PCT,leukocyte parameters,IL-6 and IL-10 in early identification of upper lobe pneumonia and upper lobular pulmonary tuberculosis［J］.Chin Trop Med,2018,18 (6):617-618,630.
［11］　CHAKRABORTY K,RAUNDHAL M,CHEN B B,et al.The mito-DAMP cardiolipin blocks IL-10 production causing persistent inflammation during bacterial pneumonia［J］.Nat Commun,2017,8:13944.
［12］　MACDONALD S P J,BOSIO E,NEIL C,et al.Resistin and NGAL are associated with inflammatory response,endothelial activation and clinical outcomes in sepsis［J］.Inflamm Res,2017,66(7):611-619.
［13］　袁雪,刘明全,黄飞,等.血清中NGAL、HE4含量变化对肺癌诊断及病情进展评估的价值［J］.海南医学院学报,2017,23(20):2838-2841.
YUAN X,LIU M Q,HUANG F,et al.Value of serum NGAL and HE4 content change for diagnosing lung cancer and evaluating disease progression［J］.J Hainan Med Univ,2017,23(20):2838-2841.
［14］　许俊旭,王振贤,邓斌,等.海口地区二级医院重症监护病房老年重症肺炎机械通气患者的病原菌调查及防治策略［J］.广西医科大学学报,2018,35(6):842-845.
XU J X,WANG Z X,DENG B,et al.Investigation and prevention of pathogenic bacteria in elderly patients with severe pneumonia treated with mechanical ventilation in intensive care unit of secondary hospitals in Haikou area［J］.J Guangxi Med Univ,2018,35 (6):842-845.
［15］　ZHAO Y,QIN L,ZHANG P,et al.Longitudinal COVID-19 profiling associates IL-1RA and IL-10 with disease severity and RANTES with mild disease［J］.JCI Insight,2020,5(13):e139834.
［16］　马叶萍,严一核,孙雪东,等.重症肺炎肺泡灌洗液的炎症因子表达水平与预后的相关性［J］.中华医院感染学杂志,2019,29(7):1007-1010.
MA Y P,YAN Y H,SUN X D,et al.Correlation between inflammatory factors expression level in severe pneumococcal alveolar lavage fluid and prognosis［J］.Chin J Nosocomiol,2019,29 (7):1007-1010.
［17］　SHI H,LAN L,LV X,et al.Effect of pidotimod combined with azithromycin on children with mycoplasma pneumonia and the expression levels of IL-10 and G-CSF in serum［J］.Exp Ther Med,2019,18(3):1800-1806.
［18］　陈燕,钱伟.慢性阻塞性肺病及吸烟人群血清MMP-9、NGAL、MMP-9/NGAL前体及中性白细胞弹性蛋白酶水平变化［J］.临床肺科杂志,2018,23(1):66-69.
CHEN Y,QIAN W.Changes of serum MMP-9,NGAL,pro MMP-9/NGAL and neutrophil elastase levels in smokers and chronic obstructive pulmonary disease patients［J］.J Clin Pulmon Med,2018,23(1):66-69.
［19］　MIN J H,LEE H,CHUNG S J,et al.Neutrophil gelatinase-associated lipocalin for predicting intensive care unit admission and mortality in patients with pneumonia［J］.Tohoku J Exp Med,2020,250(4):243-251.
［20］　朱晓颖,张倩,刘聪辉,等.NGAL、MCP-1水平对重症肺炎的诊断效能研究［J］.中国现代医学杂志,2019,29(14):73-76.
ZHU X Y,ZHANG Q,LIU C H,et al.Diagnostic efficiency of NGAL and MCP-1 levels in severe pneumonia［J］.Chin J Modern Med,2019,29(14):73-76.

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更新日期/Last Update: 2022-10-05