Analysis of the evaluation of activated protein C, endothelin-1, vascular cell adhesion molecule-1 in senile patients with severe pneumonia complicated with respiratory failure
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摘要: 目的 探讨血清活化蛋白C(APC)、内皮素1(ET-1)、血管细胞黏附分子-1(VCAM-1)对老年重症肺炎合并呼吸衰竭患者病情进展及预后评估的价值。方法 选择2019年6月-2020年6月进行治疗的87例老年重症肺炎合并呼吸衰竭患者为实验组；选择同期进行体检的80例健康人作为对照组。分析2组血清APC、ET-1、VCAM-1水平的变化情况、与病情严重程度的相关性及对预后的评估价值。结果 实验组患者血清APC水平显著低于对照组，ET-1、VCAM-1水平显著高于对照组，差异有统计学意义(P＜0.001)；低危组患者血清APC水平显著高于中危组、高危组患者，ET-1、VCAM-1水平显著低于中危组、高危组患者(P＜0.001)；中危组血清APC水平显著高于高危组，ET-1、VCAM-1水平显著低于高危组，差异有统计学意义(P＜0.001)；死亡组患者血清APC水平显著低于存活组，ET-1、VCAM-1水平显著高于存活组，差异有统计学意义(P＜0.001)。相关性分析结果显示，血清APC水平和病情严重程度之间呈负相关，ET-1、VCAM-1水平均和病情严重程度之间呈正相关(P＜0.05)。受试者工作特征曲线分析结果显示，血清APC水平预测老年重症肺炎合并呼吸衰竭不良预后的曲线下面积为0.993，最佳临界值为370.74 ng/mL；血清ET-1水平预测老年重症肺炎合并呼吸衰竭不良预后的曲线下面积为0.987，最佳临界值为1.30 ng/mL；血清VCAM-1水平预测老年重症肺炎合并呼吸衰竭不良预后的曲线下面积为0.926，最佳临界值为558.62 ng/mL。结论 血清APC、ET-1、VCAM-1水平在老年重症肺炎合并呼吸衰竭患者中表达异常，与病情程度之间关系密切，可作为判断患者病情和评估预后的参考指标。Abstract: Objective To study the value of serum activated protein C (APC), endothelin-1 (ET-1), and vascular cell adhesion molecule-1 (VCAM-1) in senile patients with severe pneumonia complicated with respiratory failure.Methods Eighty-seven elderly patients with severe pneumonia complicated with respiratory failure from June 2019 to June 2020 were selected as the experimental group, and 80 healthy people who underwent physical examination at the same time were selected as the control group. The changes of serum APC, ET-1 and VCAM-1 levels, the correlation with the severity of the disease and the evaluation of prognosis were analyzed.Results The level of serum APC in patients of experimental group was significantly lower than that of the control group, and serum ET-1 and VCAM-1 were significantly higher than those of the control group (P < 0.001). Serum APC level of patients in the low-risk group was significantly higher than that in the medium-risk group and high-risk group, and ET-1 and VCAM-1 levels were significantly lower than those in the medium-risk group and high-risk group. The serum APC of the medium-risk group was significantly higher than that of the high-risk group, and ET-1 and VCAM-1 were significantly lower than those of the high-risk group(P < 0.001). Serum APC in the death group was significantly lower than that in the survival group, and serum ET-1 and VCAM-1 were significantly higher than those in the survival group (P < 0.001).The results of correlation analysis showed that there was a negative correlation between serum APC and the degree of disease, while ET-1 and VCAM-1 were positively correlated with the degree of disease (P < 0.05).Receiveroperating characteristic curve (ROC) results showed that the area under the curve (AUC) of serum APC was 0.993, and the optimal critical value was 370.74 ng/ mL. The AUC of serum ET-1 was 0.987, and the best critical value was 1.30 ng/mL. The AUC of serum VCAM-1 was 0.926, and the best critical value was 558.62 ng/mL.Conclusion The abnormal expression of serum APC, ET-1 and VCAM-1 in elderly patients with severe pneumonia complicated with respiratory failure were closely related to the severity of the disease, which could be used as a reference index to judge the condition and evaluate the prognosis of the patients.
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Key words:
- activated protein C /
- endothelin 1 /
- vascular cell adhesion molecule-1 /
- elderly /
- severe pneumonia /
- disease progression /
- prognosis
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表 1 2组血清APC、ET-1、VCAM-1水平检测结果比较
ng/mL，X±S 组别 例数 APC ET-1 VCAM-1 实验组 87 287.56±18.34 1.97±0.23 685.26±73.04 对照组 80 456.64±18.63 0.87±0.12 441.24±58.12 t 59.068 38.251 23.755 P ＜0.001 ＜0.001 ＜0.001 
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表 2 不同危险程度老年重症肺炎合并呼吸衰竭患者血清APC、ET-1、VCAM-1水平检测结果比较
ng/mL，X±S 组别 例数 APC ET-1 VCAM-1 低危组 29 323.41±18.56 1.65±0.22 600.15±72.06 中危组 34 286.59±18.53 1.98±0.25 684.59±73.05 高危组 24 245.62±18.19 2.34±0.31 789.05±74.15 F 116.831 46.706 43.938 P ＜0.001 ＜0.001 ＜0.001
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表 3 不同预后老年重症肺炎合并呼吸衰竭患者血清APC、ET-1、VCAM-1水平检测结果比较
ng/mL，X±S 组别 例数 APC ET-1 VCAM-1 死亡组 22 251.76±18.96 3.24±0.31 941.18±86.94 存活组 65 299.68±19.05 1.54±0.24 598.64±74.59 t 10.210 26.605 17.845 P ＜0.001 ＜0.001 ＜0.001
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表 4 血清APC、ET-1、VCAM-1水平与老年重症肺炎合并呼吸衰竭患者病情严重程度的相关性分析
变量 病情严重程度 r P APC -0.295 0.002 ET-1 0.413 0.001 VCAM-1 0.385 ＜0.001
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表 5 血清APC、ET-1、VCAM-1水平对评估老年重症肺炎合并呼吸衰竭患者预后的价值
指标 最佳临界值/(ng·mL-1) 灵敏度/% 特异度/% AUC 95%CI APC 370.74 85.61 88.59 0.993 0.986~1.000 ET-1 1.30 84.57 87.16 0.987 0.970~1.000 VCAM-1 558.62 82.16 85.26 0.926 0.885~0.966
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