摘要
目的:研究血清降钙素原(PCT)、可溶性CXC趋化因子配体16(sCXCL16)、血管紧张素转换酶2(ACE2)与老年重症肺炎(SP)患者肠道菌群的相关性及其对预后的影响。方法:选择2022年10月至2023年10月本院收治的86例老年SP患者为SP组,另选择同期的40例老年健康体检者作为健康组。酶联免疫吸附(ELISA)法检测血清PCT、sCXCL16、ACE2水平;全自动微生物生长曲线分析仪检测肠道菌群;Pearson相关系数分析血清PCT、sCXCL16、ACE2与老年SP患者肠道菌群的相关性;多因素Cox回归分析老年SP患者预后的影响因素;受试者工作特征(ROC)曲线分析血清PCT、sCXCL16、ACE2对老年SP患者预后的预测价值。结果:SP组血清PCT、sCXCL16、ACE2以及乳杆菌、大肠埃希菌、肠球菌水平显著高于健康组(P<0.05),双歧杆菌水平显著低于健康组(P<0.05)。老年SP患者血清PCT、sCXCL16、ACE2水平与乳杆菌、大肠埃希菌、肠球菌均呈正相关,与双歧杆菌呈负相关(均P<0.05)。死亡组患者机械通气占比、血清PCT、sCXCL16、ACE2以及乳杆菌、大肠埃希菌、肠球菌水平显著高于生存组(P<0.05),双歧杆菌水平显著低于生存组(P<0.05)。血清PCT、sCXCL16、ACE2水平升高是老年SP患者预后的危险因素(P<0.05)。血清PCT、sCXCL16、ACE2以及三者联合预测老年SP患者预后的ROC曲线下面积(AUC)分别为0.884、0.888、0.815、0.963,三者联合预测效果更佳(Z三者联合-PCT=2.210,Z三者联合-sCXCL16=2.322,Z三者联合-ACE2=2.753,均P<0.05)。结论:老年SP患者血清PCT、sCXCL16、ACE2高表达,与肠道菌群失衡密切相关,三者联合检测对预测老年SP患者预后具有一定的价值。
Objective:To investigate the correlation of serum procalcitonin(PCT),soluble CXC chemokine ligand 16(sCXCL16),and angiotensin-converting enzyme 2(ACE2)with the intestinal flora of elderly patients with severe pneumonia(SP),and their prognostic implications.Methods:From October 2022 to October 2023,86 elderly SP patients admitted to our hospital were included as the SP group,and another 40 elderly healthy medical check-ups during the same period were selected as the healthy group.Enzyme linked immunosorbent assay(ELISA)method was applied to detect serum PCT,sCXCL16,and ACE2 levels.Fully automated microbial growth curve analyzer was used to detect intestinal flora.Pearson correlation coefficient was used to analyze the correlation between serum PCT,sCXCL16,ACE2 and intestinal flora of elderly SP patients.Multivariate Cox regression was applied to analyze the influencing factors of prognosis in elderly SP patients.The predictive value of serum PCT,sCXCL16,and ACE2 levels on the prognosis of elderly SP patients was analyzed by receiver operating characteristic(ROC)curves.Results:The serum levels of PCT,sCXCL16,ACE2,and Lactobacillus,Escherichia coli,and Enterococcus in the SP group were prominently higher than those in the healthy group(P<0.05),while the level of Bifidobacterium were prominently lower than those in the healthy group(P<0.05).The serum levels of PCT,sCXCL16,and ACE2 in elderly SP patients were positively correlated with Lactobacillus,Escherichia coli,and Enterococcus,and negatively correlated with Bifidobacterium(all P<0.05).The percentage of mechanical ventilation,serum PCT,sCXCL16,ACE2,and the levels of Lactobacillus,Escherichia coli,and Enterococcus in the death group were prominently higher than in the survival group(P<0.05),while the levels of Bifidobacterium were prominently lower than those in the survival group(P<0.05).Elevated levels of serum PCT,sCXCL16,and ACE2 were risk factors for the prognosis of elderly SP patients(P<0.05).The area under the curve(AUC)of serum PCT,sCXCL16,ACE2,and their combination of the three predicted the prognosis of elderly SP patients was 0.884,0.888,0.815,and 0.963,respectively,and the combination of the three predicted the better result(Z combination-PCT=2.210,Z combination-sCXCL16=2.322,Z combination-ACE2=2.753,all P<0.05).Conclusion:The high expression of serum PCT,sCXCL16,and ACE2 in elderly SP patients is closely related to the imbalance of intestinal flora.The combined detection of the three has certain value in predicting the prognosis of elderly SP patients.
作者
李志敏
孙敏
赵晓梅
LI Zhimin;SUN Min;ZHAO Xiaomei(Department of Geriatric II,the First Hospital of Zhangjiakou,Zhangjiakou 075000,China;Health Management Section,the First Hospital of Zhangjiakou,Zhangjiakou 075000,China)
出处
《东南大学学报(医学版)》
2025年第4期648-654,共7页
Journal of Southeast University(Medical Science Edition)
