作者：徐俊利，代宝春，闫永杰，王雅坤，张铎潇，张娟，柳敏

单位：

1.河北省邯郸市第二医院放免科2.河北省邯郸市中心医院小儿内科3.河北省邯郸市第二医院儿科

单位（英文）：

1.Department of Radiation Immunology, Handan Second Hospital, Handan 056001, China 2.Pediatric Internal Medicine, Handan Central Hospital, Handan 056001, China 3.Pediatrics, Handan Second Hospital, Handan 056001, China

关键词：

肺炎; 社区获得性肺炎; 维生素D; 白介素6; 正五聚蛋白3; N末端脑钠肽前体; 预后;

关键词（英文）：

　Pneumonia; Community acquired pneumonia; Vitamin D; Interleukin-6; Pentraxin 3; N-terminal probrain natriuretic peptide; Prognosis

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.110

基金项目：

河北省2019年度医学科学研究课题计划（20191853）；

摘要：

目的 探讨血清维生素D、IL-6、正五聚蛋白3(PTX3)、N末端脑钠肽前体（NT-proBNP）与社区获得性肺炎（CAP）患者病情严重程度的关系及其对预后的预测价值。方法 采用简单随机抽样法选取2019年6月至2021年6月邯郸市第二医院收治的CAP患者120例作为观察组，另选取同时间段来院的体检健康者35例作为对照组。采用CURB-65评分评估观察组患者CAP病情严重程度，将CURB-65评分<3分患者作为轻症亚组（n=88）,CURB-65评分≥3分者作为重症亚组（n=32）。收集所有受试者一般资料和血清25羟维生素D(25-OH-VD)、IL-6、PTX3、NT-pro BNP及观察组患者入院30 d内死亡情况。采用Pearson相关分析探讨CAP患者血清25-OH-VD、IL-6、PTX3、NTpro BNP与CURB-65评分的相关性。采用多因素Logistic回归分析探讨CAP患者入院30 d内死亡的影响因素。绘制ROC曲线以评估血清25-OH-VD、IL-6、PTX3、NT-pro BNP对CAP患者入院30 d内死亡的预测价值。结果 轻症亚组血清25-OHVD低于对照组，血清IL-6、PTX3、NT-proBNP高于对照组（P<0.05）；重症亚组血清25-OH-VD低于对照组、轻症亚组，血清IL-6、PTX3、NT-proBNP高于对照组、轻症亚组。CAP患者血清25-OH-VD与CURB-65评分呈负相关（r=-0.559），血清IL-6(r=0.827)、PTX3(r=0.699)、NT-proBNP(r=0.685)与CURB-65评分呈正相关（P<0.05）。120例CAP患者入院30 d内死亡16例，将其作为死亡亚组，其余患者作为存活亚组。死亡亚组患者年龄大于存活亚组，双肺感染者占比及血清IL-6、PTX3、NT-proBNP高于存活亚组，血清25-OH-VD低于存活亚组（P<0.05）。多因素Logistic回归分析结果显示，年龄、双肺感染及血清25-OH-VD、IL-6、PTX3、NT-pro BNP是CAP患者入院30 d内死亡的影响因素（P<0.05）。ROC曲线分析结果显示，血清25-OH-VD、IL-6、PTX3、NT-pro BNP预测CAP患者30 d内死亡的AUC分别为0.925[95%CI(0.859,0.992)]、0.942[95%CI(0.896,0.989)]、0.886[95%CI(0.805,0.967)]、0.913[95%CI(0.834,0.992)]，最佳截断值分别为16.2μg/L、155.8 ng/L、36.1μg/L、90.0 ng/L，灵敏度分别为0.875、0.938、0.938、0.875，特异度分别为0.933、0.875、0.750、0.894。结论 CAP患者血清25-OH-VD与其病情严重程度呈负相关，而血清IL-6、PTX3、NT-proBNP与其病情严重程度呈正相关。血清25-OH-VD、IL-6、PTX3、NTpro BNP是CAP患者入院30 d内死亡的影响因素，且其对CAP患者预后均有一定预测价值。

英文摘要：

Objective To investigate the relationship between serum vitamin D, IL-6, pentraxin 3 (PTX3) , N-terminal pro-brain natriuretic peptide (NT-proBNP) and the severity of disease in patients with community-acquired pneumonia (CAP) and their predictive value for prognosis. Methods A total of 120 patients with CAP admitted to Handan Second Hospital from June 2019 to June 2021 were selected as the observation group by simple random sampling, and 35 healthy individuals who came to the hospital for physical examination during the same period were selected as the control group. CURB-65 score was used to evaluate the severity of CAP in the observation group, and patients with CURB-65 score < 3 were divided into the mild subgroup (n=88) and patients with CURB-65 score ≥ 3 were divided into the severe subgroup (n=32) . General data and serum 25-hydroxyvitamin D (25-OH-VD) , IL-6, PTX3, NT-proBNP of all subjects, and death within 30 days after admission of patients in the observation group were collected. Pearson correlation analysis was used to investigate the relationship between serum 25-OH-VD, IL-6, PTX3, NT-proBNP and CURB-65 score in CAP patients. Multivariate Logistic regression analysis was used to investigate the influencing factors of death in patients with CAP within 30 days after admission. ROC curve was drawn to assess the predictive value of serum 25-OH-VD, IL-6, PTX3 and NT-proBNP for death in patients with CAP within 30 days after admission. Results Serum 25-OH-VD of mild subgroup was lower than that of control group, while serum IL-6, PTX3 and NT-proBNP were higher than those of control group (P < 0.05) . Serum 25-OH-VD in severe subgroup was lower than that in control group and mild subgroup, serum IL-6, PTX3, NT-proBNP were higher than those in control group and mild subgroup (P < 0.05) . Serum 25-OH-VD in CAP patients was negatively correlated with CURB-65 score (r=-0.559) , IL-6 (r=0.827) , PTX3 (r=0.699) , NT-proBNP (r=0.685) were positively correlated with CURB-65 score (P < 0.05) . Among 120 patients with CAP, 16 died within 30 days after admission, which were classified as the death subgroup and the rest patients were classified as the survival subgroup. Age in the death subgroup was older than that in the survival subgroup, the proportion of double-lung infection and serum IL-6, PTX3 and NTproBNP were higher than those in survival subgroup, and serum 25-OH-VD was lower than that in survival subgroup (P < 0.05) . Multivariate Logistic regression analysis showed that age, double lung infection and serum 25-OH-VD, IL-6, PTX3 and NTproBNP were the influencing factors of death in patients with CAP within 30 days after admission (P < 0.05) . ROC curve analysis results showed that the AUC of serum 25-OH-VD, IL-6, PTX3 and NT-proBNP in predicting death in CAP patients within 30 days was 0.925 [95%CI (0.859, 0.992) ] , 0.942 [95%CI (0.896, 0.989) ] , 0.886 [95%CI (0.805, 0.967) ] , 0.913 [95%CI (0.834, 0.992) ] , the optimal cut-off values were 16.2 μg/L, 155.8 ng/L, 36.1 μg/L, 90.0 ng/L, the sensitivity was 0.875, 0.938, 0.938, 0.875, and the specificity was 0.933, 0.875, 0.750, 0.894, respectively. Conclusion Serum 25-OH-VD in patients with CAP is negatively correlated with the severity of the disease, while serum IL-6, PTX3 and NT-proBNP are positively correlated with the severity of the disease. Serum 25-OH-VD, IL-6, PTX3 and NT-proBNP are the influencing factors of the death in CAP patients within 30 days after admission, and they have certain predictive value for the prognosis of CAP patients.

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