重症肺炎合并呼吸衰竭老年患者血清Msr1、TRAIL、SIRT6表达与病情及预后的相关性

Analysis of the correlation between serum Msr1, TRAIL, SIRT6 expression and disease severity and prognosis in elderly patients with severe pneumonia complicated with respiratory failure

摘要

目的 探讨重症肺炎合并呼吸衰竭老年患者血清巨噬细胞清除受体1 (Msr1)、肿瘤坏死因子相关的凋亡诱导配体 (TRAIL)、沉默信息调节因子6 (SIRT6) 表达与病情及预后的相关性。方法 选择西安高新医院2023年1月—2024年5月收治的120例重症肺炎合并呼吸衰竭老年患者 (观察组) 以及120例无呼吸衰竭的重症肺炎老年患者 (对照组) 作为研究对象, 检测血清Msr1、TRAIL、SIRT6表达水平。再根据急性生理学与慢性健康状况评分系统 (APACHE) Ⅱ评分将观察组分为低危组 (39例)、中危组 (51例) 和高危组 (30例), 比较不同组血清Msr1、TRAIL、SIRT6的表达差异。记录患者入院治疗28 d的预后状况, 分为生存组 (85例) 和死亡组 (35例), 采用多因素logistic回归模型分析影响老年重症肺炎合并呼吸衰竭患者预后的影响因素。ROC曲线分析血清Msr1、TRAIL、SIRT6对患者预后的预测价值。结果 观察组血清Msr1水平高于对照组, TRAIL、SIRT6水平低于对照组 (P<0.05)。中、高危组血清Msr1水平均高于低危组, TRAIL、SIRT6水平均低于低危组 (P<0.05); 高危组血清Msr1水平高于中危组, TRAIL、SIRT6水平低于中危组 (P<0.05)。不同预后的重症肺炎合并呼吸衰竭老年患者中, 死亡组APACHEⅡ评分>20分患者比例及血清Msr1水平高于生存组, TRAIL、SIRT6水平低于生存组 (P<0.05); 多因素logistic回归分析显示: 血清Msr1、TRAIL、SIRT6均为重症肺炎合并呼吸衰竭老年患者发生死亡的影响因素 (P<0.05)。血清Msr1、TRAIL、SIRT6单独及联合预测患者发生死亡的AUC分别为0.857、0.802、0.881、0.982, 三者联合预测效果优于各自单独预测 (P<0.05)。结论 重症肺炎合并呼吸衰竭老年患者血清Msr1水平升高, TRAIL、SIRT6水平降低, Msr1、TRAIL、SIRT6与患者的预后有一定关系。

Abstract

Objective To explore the correlation between the expressions of serum macrophage scavenger receptor 1 (Msr1), tumor necrosis factor related apoptosis inducing ligand (TRAIL), and silent information regulator 6 (SIRT6) in elderly patients with severe pneumonia complicated with respiratory failure and the disease condition and prognosis. Methods A total of 120 elderly severe pneumonia patients complicated with respiratory failure (observation group) and another 120 severe pneumonia elderly patients without respiratory failure (control group) admitted to Xi'an Gaoxin Hospital from January 2023 to May 2024 were selected as the research subjects, and the expression levels of serum Msr1, TRAIL and SIRT6 were detected. The observation group was divided into the low-risk group (39 cases), the medium-risk group (51 cases) and the high-risk group (30 cases) according to the acute physiology and chronic health evaluation (APACHE) Ⅱ score. The expression differences of serum Msr1, TRAIL and SIRT6 in different groups were compared. The prognosis of the patients 28 days after admission was recorded and they were divided into the survival group (85 cases) and the death group (35 cases). The multivariate logistic regression model was used to analyze the influencing factors affecting the prognosis of elderly patients with severe pneumonia complicated with respiratory failure. ROC curve was used to analyze the predictive value of serum Msr1, TRAIL and SIRT6 for the prognosis of patients. Results The serum Msr1 level in the observation group was higher than that in the control group, while the levels of TRAIL and SIRT6 were lower in the observation group (P<0.05). Compared with the low-risk group, the levels of serum Msr1 in both the medium-risk and high-risk groups increased, while the levels of TRAIL and SIRT6 decreased (P<0.05). Compared with the intermediate-risk group, the serum Msr1 level in the high-risk group increased, while the levels of TRAIL and SIRT6 decreased (P<0.05). Among elderly patients with severe pneumonia complicated with respiratory failure with different prognoses, compared with the survival group, the proportion of patients with APACHEⅡ score >20 scores and the serum Msr1 level in the death group increased, while the levels of TRAIL and SIRT6 decreased (P<0.05). Multivariate logistic regression analysis showed that serum Msr1, TRAIL, and SIRT6 were all influencing factors for death in elderly patients with severe pneumonia complicated with respiratory failure (P<0.05); The AUCs of serum Msr1, TRAIL, and SIRT6 alone and in combination for predicting patient death were 0.857, 0.802, 0.881, and 0.982, respectively. The combined prediction effect of the three was better than their individual predictions (P<0.05). Conclusion The serum Msr1 level of elderly patients with severe pneumonia complicated with respiratory failure is elevated, while the levels of TRAIL and SIRT6 are decreased. Msr1, TRAIL and SIRT6 have a certain relationship with the prognosis of patients.

关键词

重症肺炎 / 呼吸衰竭 / 巨噬细胞清除受体1 / 肿瘤坏死因子相关的凋亡诱导配体 / 沉默信息调节因子6

Key words

Severe pneumonia / Respiratory failure / Macrophage scavenger receptor 1 / Tumor necrosis factor related apoptosis inducing ligand / Silent information regulator 6

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基金资助

^*北京市自然科学基金项目(7222181)