血清SDC-4和NAMPT检测对重症肺炎患者预后的预测价值

杨秀锦; 胡静; 倪诤; 周吉福; 赵淼; 马素霞

doi:10.13201/j.issn.1009-5918.2025.04.006

血清SDC-4和NAMPT检测对重症肺炎患者预后的预测价值

- 1.
  首都医科大学石景山教学医院急诊科(北京，100043)
- 2.
  首都医科大学大兴教学医院感染内科

详细信息

通讯作者: 杨秀锦，E-mail：eohp1k2@163.com

中图分类号: R563.8

收稿日期: 2024-11-13

刊出日期: 2025-04-10

Predictive value of serum SDC-4 and NAMPT detection for the prognosis of severe pneumonia patients

- 1.
  Department of Emergency, Shijingshan Teaching Hospital Capital Medical University, Beijing, 100043, China
- 2.
  Department of Infectious Diseases, Daxing Teaching Hospital Capital Medical University

More Information

Corresponding author: YANG Xiujin, E-mail: eohp1k2@163.com

Received Date: 13 November 2024

Publish Date: 10 April 2025

摘要

摘要: 目的检测重症肺炎(severe pneumonia，SP)患者血清多配体蛋白聚糖4(SDC-4)、烟酰胺磷酸核糖转移酶(NAMPT)的水平，并探讨其对SP患者预后的预测价值。方法选取首都医科大学石景山教学医院急诊科在2021年3月-2023年3月期间收治的132例SP患者为研究对象(SP组)，另同期选取本院治疗的132例非重症肺炎患者为非SP组和132例健康体检者为对照组。132例SP患者入院治疗28 d后依据其预后情况分为预后良好组(92例)、预后不良组(40例)。采用酶联免疫吸附法检测血清SDC-4、NAMPT水平Pearson分析SP患者血清SDC-4、NAMPT水平与临床肺部感染评分(CPIS)的关系；多因素logistic回归模型分析影响SP患者预后的因素；受试者工作特征(ROC)曲线评估血清SDC-4、NAMPT水平在预测SP患者预后方面的效能。结果 SP组患者血清SDC-4水平明显低于对照组及非SP组，而血清NAMPT水平明显高于对照组及非SP组，差异有统计学意义(P＜0.05)；预后不良组糖尿病史患者占比、CPIS评分、血清NAMPT水平均显著高于预后良好组，差异有统计学意义(P＜0.05)，血清SDC-4水平显著低于预后良好组，差异有统计学意义(P＜0.05)；血清SDC4水平与CPIS评分呈负相关(P＜0.05)，血清NAMPT水平与CPIS评分呈正相关(P＜0.05)；糖尿病史、CPIS评分、血清NAMPT、SDC-4均是影响SP患者预后的相关因素(P＜0.05)；血清SDC-4、NAMPT水平预测SP患者不良预后的AUC分别为0.800、0.829，二者联合预测SP患者不良预后的AUC为0.888，二者联合优于血清SDC-4、NAMPT各自单独预测(Z_{二者联合-SDC-4}=2.154、Z_{二者联合-NAMPT}=2.550，P=0.031、0.011)。结论 SP患者血清SDC-4水平降低，NAMPT水平升高，均是SP患者预后影响因素，且二者联合对预测SP患者预后不良的效能更高。
- 重症肺炎 /
- 多配体蛋白聚糖4 /
- 烟酰胺磷酸核糖转移酶 /
- 预后 /
- 预测价值
Abstract: Objective To detect the levels of serum syndecan-4 (SDC-4) and nicotinamide phosphoribosyltransferase(NAMPT) in patients with severe pneumonia (SP), and explore their predictive value for prognosis.Methods A total of 132 SP patients admitted to our hospital between March 2021 and March 2023 were regarded as the study subjects(SP group), 132 non-SP patients treated in our hospital were selected as the non-SP group, 132 healthy individuals were selected as the control group. After 28 days of hospitalization, SP patients were separated into a good prognosis group (n=92) and a poor prognosis group (n=40) based on their prognosis. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum SDC-4 and NAMPT levels. Clinical data of patients were collected. The general information of the poor prognosis group and the good prognosis group were compared. Pearson method was applied to analyze the relationship between serum SDC-4, NAMPT levels and CPIS score in SP patients. The logistic regression model was applied to analyze the factors affecting the prognosis of SP patients. Receiver operating characteristic (ROC) curve was applied to analyze the predictive value of serum SDC-4 and NAMPT levels for poor prognosis in SP patients.Results The serum SDC4 level in the SP group was lower than that in the control group and the non-SP group, and the serum NAMPT level was higher than that in the control group and the non-SP group (P < 0.05). The proportion of patients with diabetes history, CPIS score and serum NAMPT level in the poor prognosis group were obviously higher than those in the good prognosis group (P < 0.05), and the serum SDC-4 level was obviously lower than that in the good prognosis group (P < 0.05). The serum SDC4 level was negatively correlated with CPIS score (P < 0.05), while the serum NAMPT level was positively correlated with CPIS score (P < 0.05). The history of diabetes, CPIS score, serum NAMPT and SDC-4 were related factors affecting the prognosis of SP patients (P < 0.05). The AUC for predicting poor prognosis in SP patients with serum SDC-4 and NAMPT levels was 0.800 and 0.829, respectively. The AUC for predicting poor prognosis in SP patients with a combination of the two was 0.888. The combination of the two was better than the independent prediction of serum SDC-4 and NAMPT levels (Z_{combination-SDC-4}=2.154, Z_{combination-NAMPT}=2.550, P=0.031, 0.011).Conclusion The in serum SDC-4 level decreases and the in NAMPT level increases in SP patients, they are both prognostic factors, and the combined detection of the two is more effective in predicting poor prognosis in SP patients.
- severe pneumonia /
- syndecan-4 /
- nicotinamide phosphoribosyltransferase /
- prognosis /
- predictive value

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图 1 血清SDC-4、NAMPT水平与CPIS评分的相关性分析

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图 2 血清SDC-4、NAMPT水平预测SP患者预后的ROC曲线

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表 1 SP组、非SP组和对照组血清SDC-4、NAMPT水平比较 X±S

组别	例数	SDC-4/(ng/mL)	NAMPT/(ng/mL)
SP组	132	6.35±1.31¹⁾	5.15±0.81¹⁾
非SP组	132	8.16±1.75²⁾	4.41±0.65²⁾
对照组	132	11.27±2.16	2.68±0.51
F	-	259.652	475.336
P	-	＜0.001	＜0.001
与非SP组相比，¹⁾P＜0.05；与对照组相比，²⁾P＜0.05。

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表 2 不同预后组临床资料比较 X±S

临床资料	预后良好组(92例)	预后不良组(40例)	t/χ²	P
性别/例(%)			0.512	0.474
男	49(53.26)	24(60.00)
女	43(46.74)	16(40.00)
≥65岁/例(%)	39(42.39)	23(57.50)	2.555	0.110
BMI/(kg/m²)	23.21±2.64	22.79±2.47	0.856	0.393
糖尿病史/例(%)			8.502	0.004
有	39(42.39)	28(70.00)
无	53(57.61)	12(30.00)
高血压史/例(%)			0.244	0.622
有	48(52.17)	19(47.50)
无	44(47.83)	21(52.50)
吸烟史/例(%)			0.030	0.862
有	29(31.35)	12(30.00)
无	63(68.48)	28(70.00)
酗酒史/例(%)			2.652	0.103
有	16(17.39)	12(30.00)
无	76(82.61)	28(70.00)
合并新冠感染/例(%)			2.111	0.146
是	35(38.04)	10(25.00)
否	57(61.96)	30(75.00)
CPIS评分/分	4.65±0.84	7.33±1.40	13.604	＜0.001

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表 3 两组患者血清SDC-4、NAMPT水平比较 X±S

组别	例数	SDC-4/(ng/mL)	NAMPT/(ng/mL)
预后不良组	40	5.42±0.61	5.79±0.58
预后良好组	92	6.75±1.32	4.86±0.73
t	-	6.086	7.133
P	-	＜0.001	＜0.001

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表 4 SP患者预后影响因素分析

影响因素	β	SE	Wald χ²	P	OR	95%CI
SDC-4	-0.176	0.083	4.473	0.009	0.839	0.713~0.987
NAMPT	0.701	0.074	10.371	0.011	1.802	1.559~2.083
糖尿病史	0.976	0.421	4.264	0.018	2.653	1.183~5.949
CPIS评分	0.208	0.065	10.223	0.001	1.231	1.084~1.398

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