| 潘娜,陈乾华,辛丽云,等.老年重症肺炎病人病原菌分布和血清 SACE、锁链素与病情及预后的相关性[J].安徽医药,2025,29(6):1246-1250. |
| 老年重症肺炎病人病原菌分布和血清 SACE、锁链素与病情及预后的相关性 |
| Distribution of pathogenic bacteria in elderly patients with severe pneumonia and the correlation between serum SACE, desmosine and condition, prognosis |
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| DOI：10.3969/j.issn.1009-6469.2025.06.038 |
| 中文关键词: 肺炎 血清血管紧张素转换酶 锁链素 病原菌分布 老年人 预后 |
| 英文关键词: Pneumonia Serum angiotensin converting enzyme Desmosine Distribution of pathogenic bacteria Aged Prog-nosis |
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| 中文摘要: |
| 目的探究老年重症肺炎( SP)病人病原菌分布和血清血管紧张素转换酶( SACE)、锁链素与病情及预后的相关性。方选取航空总医院 SP病人作为观察组，体检的健康人员作为对照组，各 95例，均于 2020年 4月至 2023年 4月收治。根据 SP病法人病情严重程度将观察组分为低危组( 26例)、中危组(34例)、高危组( 35例)比较各组血清 SACE、锁链素水平，并分析病原菌分布情况。观察组 28 d随访后根据病人的生存情况分为两组:存活纳入预后良，好组( 67例)，死亡纳入预后不良组( 28例)，采用受试者操作特征曲线( ROC曲线)检验血清 SACE、锁链素对 SP病人预后不良的诊断价值， logistic回归分析探索 SP病人预后不良的影响因素。结果共培养出 109株病原菌，其中革兰阴性菌 71株，革兰阳性菌 22株，真菌 16株。观察组血清 SACE［( 34.38±3.54)U/L］、锁链素［( 24.22±2.78)mg/L］水平比对照组的［( 25.87±2.65)U/L、(18.37±2.28)mg/L］高( P<0.05)。低危组、中危组、高危组血清 SACE、锁链素水平逐渐升高(P<0.05)。预后不良组 IL-6、PCT、CRP、SACE、锁链素水平比预后良好组高(P< 0.05)。 ROC分析显示，血清 SACE、锁链素水平辅助诊断发生预后不良的曲线下面积( AUC)及其 95%CI是 0.81(0.71，0.91)、 0.79(0.70，0.88)，二者联合预测的 AUC及其 95%CI为 0.92(0.87，0.97)均优于各自单独检测( Z=2.65、3.29，P<0.05)。 logistic结果显示，血清 SACE［OR=2.90，95%CI:(1.57，5.36)］、锁链素［ OR=2.865%CI:(1.54，5.33)］水平是影响 SP病人发生预后不良的危险因素(P<0.05)。结论老年 SP病人感染的病原菌主要为革兰阴性菌，病人血清 SACE、锁链素水平升高，且二者与病情，9，及预后关系密切。 |
| 英文摘要: |
| Objective To investigate the distribution of pathogenic bacteria and the correlation between serum angiotensin convertingenzyme (SACE), desmosine and the condition, prognosis in elderly patients with severe pneumonia (SP).Methods Patients with SP inthe Aviation General Hospital were regarded as the observation group, and healthy people undergoing physical examination were select-ed as the control group, with 95 cases in each group. All patients were admitted from April 2020 to April 2023. According to the severi-ty of condition, the observation group was assigned into a low-risk group (n=26), a medium-risk group (n=34), and a high-risk group (n= 35). The levels of serum SACE and desmosine were compared among groups, and the distribution of pathogenic bacteria was analyzed.After 28 d follow-up, the patients were assigned into two groups according to their survival status: those who survived were included inthe group with good prognosis (n=67), while those who died were included in the group with poor prognosis (n=28). The receiver operat-ing characteristic curve (ROC curve) was used to test the diagnostic value of serum SACE and desmosine for poor prognosis in SP pa-tients, and logistic regression analysis was made to explore the risk factors for poor prognosis in SP patients.Results A total of 109 pathogenic bacteria were cultured in this study, including 71 strains of Gram negative bacteria, 22 strains of Gram positive bacteria,and 16 strains of fungi. The serum levels of SACE and desmosine in the observation group were higher than those in the control group[(34.38±3.54) U/L vs. (25.87±2.65) U/L, (24.22±2.78) mg/L vs. (18.37±2.28) mg/L] (P<0.05). The serum levels of SACE and desmosine gradually increased in the low-risk, medium risk, and high-risk groups (P<0.05). The levels of IL-6, PCT, CRP, SACE, and desmosine in the poor prognosis group were higher than those in the good prognosis group (P<0.05). ROC analysis results showed that the area un-der the curve (AUC) and 95%CI of serum SACE and desmosine levels for assisting in the diagnosis of poor prognosis were 0.81 (0.71,0.91) and 0.79 (0.70,0.88), and the AUC and 95%CI predicted by the combination of the two was 0.92 (0.87,0.97), both of which were better than the individual tests (Z=2.65, 3.29, P<0.05). Logistic analysis results showed that serum SACE [OR=2.90, 95%CI: (1.57, 5.36)] and desmosine [OR=2.86, 95%CI: (1.54, 5.33)] levels were risk factors for poor prognosis in SP patients (P<0.05).Conclusions The main pathogen of infection in elderly SP patients is Gram negative bacteria. The levels of serum SACE and desmosine in the pa-tients increase, which are closely related to the condition and prognosis of the disease. |
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