[1]马群,李卫阳,许蒙.老年重症肺炎并呼吸衰竭患者血清可溶性CD40配体和正五聚体蛋白-3水平变化及临床意义[J].新乡医学院学报,2023,40(7):659-663.[doi:10.7683/xxyxyxb.2023.07.011]
　MA Qun,LI Weiyang,XU Meng.Changes and clinical significance of serum soluble CD40 ligand and pentraxin-3 levels in elderly patients with severe pneumonia and respiratory failure[J].Journal of Xinxiang Medical University,2023,40(7):659-663.[doi:10.7683/xxyxyxb.2023.07.011]
点击复制

老年重症肺炎并呼吸衰竭患者血清可溶性CD40配体和正五聚体蛋白-3水平变化及临床意义
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年7
页码:
659-663
栏目:
临床研究
出版日期:
2023-07-05

文章信息/Info

Title:
Changes and clinical significance of serum soluble CD40 ligand and pentraxin-3 levels in elderly patients with severe pneumonia and respiratory failure
作者:
马群; 李卫阳; 许蒙
（南阳市第一人民医院呼吸与危重症医学二科，河南　南阳　473000）
Author(s):
MA Qun; LI Weiyang; XU Meng
（Second Department of Respiratory and Critical Care Medicine,Nanyang First People’s Hospital,Nanyang 473000,Henan Province,China）
关键词:
重症肺炎; 呼吸衰竭; 血清可溶性CD40配体; 正五聚体蛋白-3
Keywords:
severe pneumonia; respiratory failure; serum soluble CD40 ligand; pentraxin-3
分类号:
R653.1
DOI:
10.7683/xxyxyxb.2023.07.011
文献标志码:
A
摘要:
目的　探讨老年重症肺炎并呼吸衰竭患者血清可溶性CD40配体（CD40L）、正五聚体蛋白-3（PTX3）水平变化及临床意义。
方法　选择2020年1月至2022年1月南阳市第一人民医院收治的98例老年重症肺炎并呼吸衰竭患者为研究对象。收集患者的年龄、性别、是否吸烟、基础疾病（糖尿病、冠状动脉性心脏病、高血压、慢性阻塞性肺疾病）、是否行机械通气以及血白细胞计数、血清白蛋白和血红蛋白水平等一般临床资料。采集患者入院后24 h内的空腹外周静脉血，采用酶联免疫吸附法检测血清CD40L、PTX3水平。入院后24 h内行急性生理学与慢性健康状况评价Ⅱ（APACHE Ⅱ）评分，根据APACHE Ⅱ评分将患者分为低危组（<10分，n=25）、中危组（10~20分,n=40）、高危组（>20分,n=33），比较3组患者的血清CD40L、PTX3水平；根据患者入院后30 d内是否死亡，将患者分为死亡组（n=69）和存活组（n=29），比较2组患者的血清CD40L、PTX3水平、APACHE Ⅱ评分及其他临床资料；采用logistic回归分析患者预后影响因素，受试者操作特征（ROC）曲线分析血清CD40L、PTX3水平对患者预后的预测价值。
结果　低危组、中危组和高危组患者血清CD40L、PTX3水平比较差异有统计学意义（F=28.690、199.407，P<0.05）；中危组和高危组患者血清CD40L、PTX3水平显著高于低危组，高危组患者血清CD40L、PTX3水平显著高于中危组（P<0.05）。 死亡组与存活组患者的性别、年龄、吸烟占比、患基础疾病占比、白细胞计数、白蛋白水平、血红蛋白水平比较差异无统计学意义（P>0.05）；死亡组患者机械通气占比、血清CD40L和PTX3水平及APACHE Ⅱ评分均显著高于存活组（P<0.05）。Logistic回归分析结果显示，机械通气、血清CD40L和PTX3水平及APACHE Ⅱ评分为老年重症肺炎并呼吸衰竭患者死亡的危险因素（P<0.05）。以11.52 μg·L-1为最佳截断值，血清CD40L水平预测老年重症肺炎并呼吸衰竭患者死亡的灵敏度和特异度分别为75.86%和76.81%，曲线下面积（AUC）为0.733；以14.19 μg·L-1为最佳截断值，血清PTX3水平预测老年重症肺炎并呼吸衰竭患者死亡的灵敏度和特异度分别为68.97%和79.71%，AUC为0.701；血清CD40L与PTX3水平联合预测老年重症肺炎并呼吸衰竭患者死亡的灵敏度和特异度分别为93.10%和79.71%，AUC为0.906；血清CD40L与PTX3水平联合预测老年重症肺炎并呼吸衰竭患者死亡的AUC高于CD40L、PTX3水平单独预测（P<0.05）。
结论　血清CD40L、PTX3与老年重症肺炎并呼吸衰竭患者的病情严重程度有关，是患者死亡的独立危险因素，血清CD40L和PTX3联合检测对老年重症肺炎并呼吸衰竭患者的预后有较高的临床预测价值。
Abstract:
Objective　To investigate the changes of the levels of serum soluble CD40 ligand(CD40L) and pentraxin-3(PTX3) in elderly patients with severe pneumonia and respiratory failure and their clinical significance.
Methods　A total of 98 elderly patients with severe pneumonia and respiratory failure admitted to Nanyang First People’s Hospital from January 2020 to January 2022 were selected as the research objects.The general clinical data including the age,gender,smoking,basic diseases(diabetes,coronary heart disease,hypertension,chronic obstructive pulmonary disease),mechanical ventilation,white blood cell count,serum albumin and hemoglobin were collected.The fasting peripheral venous blood of patients within 24 hours after admission was collected,and the serum CD40L and PTX3 levels were detected by enzyme-linked immunosorbent assay.The patients all underwent acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score within 24 hours after admission,and the patients were divided into low-risk group(<10 points,n=25),medium-risk group(10-20 points,n=40) and high-risk group(>20 points,n=33) according to the APACHEⅡ score;the serum CD40L and PTX3 levels of patients were compared among the three groups.According to whether the patients died within 30 days after admission,the patients were divided into death group(n=69) and survival group(n=29);the serum CD40L and PTX3 levels,APACHEⅡ score and general clinical data of patients between the two groups were compared.The prognostic factors of patients were analyzed by logistic regression analysis,and the value of serum CD40L and PTX3 levels in predicting the prognosis of patients was analyzed by receiver operating characteristic(ROC) curve.
Results　There were significant differences in serum CD40L and PTX3 levels among the low-risk group,medium-risk group and high-risk group（F=28.690,199.407;P<0.05）;the serum CD40L and PTX3 levels of patients in the medium-risk group and high-risk group were significantly higher than those in the low-risk group,while the serum CD40L and PTX3 levels of patients in the high-risk group were significantly higher than those in the medium-risk group(P<0.05).There was no statistically significant difference in gender,age,proportion of smoking,proportion of underlying diseases,white blood cell count,albumin level and hemoglobin level of patients between the death group and the survival group(P>0.05);the proportion of mechanical ventilation,serum CD40L and PTX3 levels,and APACHEⅡ score of patients in the death group were significantly higher than those in the survival group(P<0.05).Logistic regression analysis showed that mechanical ventilation,serum CD40L level,serum PTX3 level and APACHE Ⅱ score were the risk factors for death in elderly patients with severe pneumonia and respiratory failure(P<0.05).Taking 11.52 μg· L-1 as the optimal cutoff value,the sensitivity and specificity of serum CD40L level in predicting mortality in elderly patients with severe pneumonia and respiratory failure were 75.86% and 76.81%,respectively,and the area under the curve(AUC) was 0.733;taking 14.19 μg · L-1 as the optimal cutoff value,the sensitivity and specificity of serum PTX3 levels in predicting mortality in elderly patients with severe pneumonia and respiratory failure were 68.97% and 79.71%,respectively,with an AUC of 0.701;the sensitivity and specificity of combining serum CD40L and PTX3 levels in predicting mortality in elderly patients with severe pneumonia and respiratory failure were 93.10% and 79.71%,respectively,with an AUC of 0.906;the AUC of serum CD40L level combined with serum PTX3 level in predicting mortality in elderly patients with severe pneumonia and respiratory failure was significantly higher than that of serum CD40L and PTX3 levels alone(P<0.05).
Conclusion　Serum CD40L and PTX3 are associated with the severity of the elderly patients with severe pneumonia and respiratory failure,and which are independent risk factors for death of the patients.The combined detection of serum CD40L and PTX3 has higher clinical predictive value for the prognosis of elderly patients with severe pneumonia and respiratory failure.

参考文献/References:

［1］　周瑜,代艳梅,王一平,等.老年重症肺炎患者细胞炎性因子、凝血功能情况及预后的影响因素分析［J］.临床肺科杂志,2020,25(1):70-73.
ZHOU Y,DAI Y M,WANG Y P,et al.Analysis of cytoinflammatory factors,coagulation function and prognostic factors in elderly patients with severe pneumonia［J］.J Clin Pulmon Med,2020,25(1):70-73.
［2］　邵婷婷.各血小板参数检测联合肺炎严重指数评分在重症肺炎患者中的死亡率预测作用分析［J］.中国卫生检验杂志,2020,30(4):402-404,407.
SHAO T T.Combined detection of platelet parameter and PSI score in predicting the mortality of patients with severe pneumonia［J］.Chin J Health Lab Technol,2020,30(4):402-404,407.
［3］　TANG T,CHENG X,TRUONG B,et al.Molecular basis and therapeutic implications of CD40/CD40L immune checkpoint［J］.Pharmacol Ther,2021,219:107709.
［4］　HILL G R,KOYAMA M.Cytokines and costimulation in acute graft-versus-host disease［J］.Blood,2020,136(4):418-428.
［5］　GEN A B,YAYLACI S,DHEIR H,et al.The predictive and diagnostic accuracy of long pentraxin-3 in COVID-19 pneumonia［J］.Turk J Med Sci,2021,51(2):448-453.
［6］　中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南［J］.中华结核和呼吸杂志,2006,29(10):651-655.
CHINESE SOCIETY OF RESPIRATORY MEDICINE.Guidelines for diagnosis and treatment of community-acquired pneumonia［J］.Chin J Tub Respir Dis,2006,29(10):651-655.
［7］　谢小兵,高云,刘凯,等.中性粒细胞/淋巴细胞比值对呼吸机相关性肺炎病情严重程度及预后的评估价值［J］.河北医学,2020,26(1):8-13.
XIE X B,GAO Y,LIU K,et al.The value of neutrophil/lymphocyte ratio in assessing the severity and prognosis of ventilator-associated pneumonia［J］.J Hebei Med,2020,26(1):8-13.
［8］　EHRMANN S,LI J,IBARRA-ESTRADA M,et al.Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure:a randomised,controlled,multinational,open-label meta-trial［J］.Lancet Respir Med,2021,9(12):1387-1395.
［9］　CARPAGNANO G E,DI LECCE V,QUARANTA V N,et al.Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19［J］.J Endocrinol Invest,2021,44(4):765-771.
［10］　陈晗璐,吴盛海.肺炎支原体感染的致病机制及实验室检测［J］.国际流行病学传染病学杂志,2022,49(2):134-138.
CHEN H L,WU S H.Pathogenic mechanism and laboratory detection of Mycoplasma pneumoniae infection［J］.Int J Epidemiol Infect Dis,2022,49(2):134-138.
［11］　汤雯,罗佳,姜春燕,等.高龄社区获得性肺炎患者短期预后与衰弱状态的相关性［J］.中华老年多器官疾病杂志,2020,19(9):646-650.
TANG W,LUO J,JIANG C Y,et al.Correlation of frailty status and short-term prognosis of community-acquired pneumonia in very old patients［J］.Chin J Mult organ Dis Eldely,2020,19(9):646-650.
［12］　SHIN J J,CATANZARO J,YONKOF J R,et al.Infectious complications predict premature CD8+T-cell senescence in CD40 ligand-deficient patients［J］.J Clin Immunol,2021,41(4):795-806.
［13］　SONI C,PEREZ O A,VOSS W N,et al.Plasmacytoid dendritic cells and type I interferon promote extrafollicular B cell responses to extracellular self-DNA［J］.Immunity,2020,52(6):1022- 1038.
［14］　SAADI F,CHAKRAVARTY D,KUMAR S,et al.CD40L protects against mouse hepatitis virus-induced neuroinflammatory demyelination［J］.PLoS Pathog,2021,17(12):e1010059.
［15］　王小花,林坚,邢东文,等.支气管哮喘并发肺部感染患儿血清CD40L及VCAM-1的表达及临床意义［J］.中华医院感染学杂志,2020,30(16):2536-2539.
WANG X H,LIN J,XING D W,et al.Expression of serum CD40L and VCAM-1 in bronchial asthma children complicated with pulmonary infection and clinical significance［J］.Chin J Nosocomiol,2020,30(16):2536-2539.
［16］　BRUNETTA E,FOLCI M,BOTTAZZI B,et al.Macrophage expression and prognostic significance of the long pentraxin PTX3 in COVID-19［J］.Nat Immunol,2021,22(1):19-24.
［17］　ASGARI F,SUPINO D,PARENTE R,et al.The long pentraxin PTX3 controls klebsiella pneumoniae severe infection［J］.Front Immunol,2021,12:666198.
［18］　SHI G Q,YANG L,SHAN L Y,et al.Investigation of the clinical significance of detecting PTX3 for community-acquired pneumonia［J］.Eur Rev Med Pharmacol Sci,2020,24(16):8477-8482.

相似文献/References:

[1]郜素云,薛训杰,齐文清,等.肝素佐治重症肺炎(附20例报告)[J].新乡医学院学报,1993,10(04):287.
[2]赵畅,潘艳萍.氧气疗法治疗Ⅱ型呼吸衰竭18例[J].新乡医学院学报,1996,13(02):158.
[3]李国保.经鼻面罩压力支持通气治疗慢性阻塞性肺病呼吸衰竭[J].新乡医学院学报,2002,19(04):293.
[4]宋振风,刘志强,董静.序贯性机械通气治疗老年慢性阻塞性肺疾病重度呼吸衰竭[J].新乡医学院学报,2002,19(04):295.
[5]姜建慧,洪　敏,王海燕,等.无创正压通气治疗急性呼吸衰竭42 例护理体会[J].新乡医学院学报,2003,20(04):296.
[6]姜建慧,洪 敏,王海燕,等.无创正压通气治疗急性呼吸衰竭42例护理体会[J].新乡医学院学报,2003,20(04):296.
[7]胡继梅,徐欣欣,刘　爽.双水平气道正压通气治疗呼吸衰竭38 例护理体会[J].新乡医学院学报,2006,23(06):628.
[8]王红梅,黄丽蓉.重症肺炎患者细胞免疫功能研究[J].新乡医学院学报,2011,28(06):000.
[9]臧　宁,潘海祥,李荣新,等.降钙素原和 Ｃ反应蛋白联合检测在重症肺炎患儿病情和预后评估中的价值[J].新乡医学院学报,2015,32(09):849.
[10]沙正凯,钱　江,张祥杰,等.抗感染联合纤维支气管镜吸痰治疗对重症肺炎患者症状缓解及炎性反应的影响[J].新乡医学院学报,2016,33(12):1091.[doi:10.7683/xxyxyxb.2016.12.020]
　SHA Zheng-kai,QIAN Jiang,ZHANG Xiang-jie,et al.Effect of anti infection combined with fiexible bronchofiberscope aspiration of sputum therapy on symptoms and inflammatory response in patients with severe pulmonary infection[J].Journal of Xinxiang Medical University,2016,33(7):1091.[doi:10.7683/xxyxyxb.2016.12.020]

更新日期/Last Update: 2023-07-05