干扰素诱导蛋白3联合降钙素原对老年重症肺结核患者预后的评估价值

doi:10.19983/j.issn.2096-8493.2024030

摘要/Abstract

摘要：

目的：探讨干扰素诱导蛋白3(IFIT3)联合血清降钙素原(procalcitonin, PCT)对老年重症肺结核患者预后的评估价值。方法：采用前瞻性研究方法,收集2022年4月至2023年3月河北省胸科医院重症监护病房 82例老年重症肺结核患者作为研究对象,根据患者入住重症监护病房28d转归分为存活组(42例)和死亡组(40例)。收集两组患者的临床资料,采用酶联免疫吸附法(ELISA)测定血清IFIT3及PCT含量。以入重症监护病房28d预后情况为参照标准,绘制受试者工作特征(ROC)曲线分析IFIT3和PCT对老年重症肺结核患者死亡的预测价值。结果：死亡组的急性生理学及慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、血清IFIT3含量和PCT含量,分别为(25.68±8.12)分、21.00(13.00, 48.00)pg/ml及3.21(0.96, 5.78)ng/ml,均高于存活组[分别为(21.17±8.57)分,11.00(5.75, 22.75)pg/ml及0.41(0.15, 1.04)ng/ml],差异均有统计学意义(t=-2.373, P=0.018;Z=-2.920, P=0.003;Z=2.028,P=0.001)。以入住重症监护病房 28d预后情况为参考标准,IFIT3和PCT预测老年重症肺结核患者死亡的ROC曲线下面积(AUC)分别为0.687(95%CI:0.572~0.803)、0.832(95%CI:0.741~0.922)。IFIT3最佳临界值为12.50pg/ml时,预测老年重症肺结核患者死亡的敏感度为77.5%和特异度为59.5%;血清PCT最佳临界值为1.44ng/ml时,预测老年重症肺结核患者死亡的敏感度为72.5%和特异度为83.3%;IFIT3联合PCT预测老年重症肺结核患者死亡的AUC为0.850(95%CI:0.767~0.933),敏感度和特异度分别为75.0%和83.3%,阳性预测值和阴性预测值分别为81.1%和75.6%。结论：IFIT3联合PCT检测对老年重症肺结核患者的预后评估有一定的临床价值。

关键词: 干扰素诱导剂, 重症监护病房, 老年人, 预测

Abstract:

Objective: To investigate the value of IFIT3 (interferon-induced protein with tetratricopeptide repeats 3,IFIT3) and procalcitonin (PCT) in the prognosis of elderly patients with severe pulmonary tuberculosis (PTB). Methods: In this prospective study, 82 elderly patients with severe PTB in the ICU of Hebei Chest Hospital from April 2022 to March 2023 were selected as study objects, and divided into survival group (42 cases) and death group (40 cases) according to the outcomes of the patients after they admitted to the ICU for 28 days. Clinical data of these two groups of patients were collected, and serum IFIT3 and PCT contents were determined by enzyme-linked immunosorbent assay (ELISA). The predictive value of IFIT3 and PCT on death was then analyzed by plotting receiver operating characteristic (ROC) curve, while the prognosis at 28 days after admission to ICU was used as the reference standard. Results: The acute physiology and chronic health status assessment system Ⅱ (APACHEⅡ) score, serum IFIT3 and PCT level of the elderly patients with severe PTB in the death group were 25.68±8.12, 21.00 (13.00, 48.00) pg/ml and 3.21 (0.96, 5.78) ng/ml, respectively, higher than those in the survival group (21.17±8.57, 11.00 (5.75, 22.75) pg/ml and 0.41 (0.15, 1.04) ng/ml). The differences were statistically significant (t=-2.373, P=0.018;Z=-2.920, P=0.003;Z=2.028, P=0.001). The area under ROC curve (AUC) of IFIT3 and PCT were 0.687 (95%CI:0.572-0.803) and 0.832 (95%CI:0.741-0.922) respectively for predicting death. When the optimal threshold value of IFIT3 was 12.50 pg/ml, the sensitivity and specificity of predicting death were 77.5% and 59.5%. When the optimal threshold of serum PCT was 1.44 ng/ml, the sensitivity and specificity of predicting death were 72.5% and 83.3%. AUC of combing IFIT3 with PCT in predicting death was 0.850 (95%CI: 0.767-0.933), the sensitivity and specificity were 75.0% and 83.3%, and the positive predictive value and negative predictive value were 81.1% and 75.6%. Conclusion: IFIT3 combined with PCT test has a certain clinical value in the prognosis assessment of elderly patients with severe PTB in ICU.

Key words: Interferon inducers, Intensive care units, Aged, Forecasting

中图分类号:

魏云霞, 王鑫, 龙雪娟, 邵丽娇, 闫丽静, 于娣, 李宁. 干扰素诱导蛋白3联合降钙素原对老年重症肺结核患者预后的评估价值[J]. 结核与肺部疾病杂志, 2024, 5(2): 143-147. doi: 10.19983/j.issn.2096-8493.2024030

Wei Yunxia, Wang Xin, Long Xuejuan, Shao Lijiao, Yan Lijing, Yu Di, Li Ning. Clinical value of IFIT3 and PCT in prognosis evaluation of elderly patients with severe tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(2): 143-147. doi: 10.19983/j.issn.2096-8493.2024030

图/表 2

表1

生存组与死亡组患者一般情况比较

指标	生存组(42例)	死亡组(40例)	统计检验值	P值
年龄[岁,M(Q₁, Q₃)]	69.00(63.00,76.25)	66(60.00,74.00)	Z=-0.916	0.360
性别[例,构成比(%)]			χ²=1.334	0.342
男性	34(80.95)	29(72.50)
女性	8(19.05)	11(27.50)
BMI( $x ˉ$ ±s)	22.16±4.19	20.08±3.91	t=-2.157	0.031
WBC[×10⁹/L,M(Q₁, Q₃)]	9.25(6.08,14.30)	9.99(5.91,14.50)	Z=-0.232	0.817
Hb(g/L, $x ˉ$ ±s)	107.98±24.23	97.75±21.44	t=-1.759	0.079
D二聚体[ng/L,M(Q₁, Q₃)]	2.74(1.55,5.04)	4.46(2.01,6.95)	Z=-1.726	0.084
CRP [mg/L,M(Q₁, Q₃)]	71.40(41.20,128.90)	139.90(75.50,120.00)	Z=-2.301	0.021
OI [mmHg,M(Q₁, Q₃)]	118.00(97.50,189.00)	105.00(91.00,135.50)	Z=-1.838	0.066
APACHEⅡ (分, $x ˉ$ ±s)	21.17±8.57	25.68±8.12	t=-2.373	0.018

表1

图1

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