血清可溶性程序性死亡受体1与重症监护病房中肺结核患者病情及预后的关系研究

doi:10.19983/j.issn.2096-8493.20250032

摘要/Abstract

摘要：

目的: 探讨血清可溶性程序性死亡受体1(programmed death receptor-1, PD-1)对重症监护病房(intensive care unit, ICU)中肺结核患者病情程度和预后的评估价值。方法: 选取2022年4月至2024年4月河北省胸科医院ICU收治的肺结核患者102例作为研究对象,依据患者进入ICU后28d生存状态(生存与否)分为生存组和死亡组。对比两组患者的血清可溶性PD-1水平,分析其与ICU肺结核患者病情、预后评分及营养指标的相关性。采用受试者工作特征(receiver operating characteristic, ROC)曲线分析血清可溶性PD-1对ICU肺结核患者预后的评估价值。结果: 102例入住ICU的肺结核患者中,死亡42例(死亡组),死亡率为41.2%(42/102);生存60例(生存组),生存率为58.8%(60/102)。与生存组比较,死亡组血清可溶性PD-1水平升高[47.25(41.48,51.15)pg/ml vs. 35.45(28.40,41.80)pg/ml;Z=―6.399,P<0.001]。PD-1与APACHEⅡ评分、SOFA评分均呈正相关(r=0.580,P<0.001;r=0.575,P<0.001),与前白蛋白呈负相关(r=―0.297,P=0.002),与乳酸不相关(r=0.104,P=0.297)。ROC曲线分析显示,血清可溶性PD-1预测入住ICU的肺结核患者死亡的ROC曲线下面积为0.873(95%CI:0.809~0.938),最佳临界值为38.45pg/ml时,预测敏感度为95.2%,特异度为65.0%;与APACHEⅡ联合时,敏感度>99.9%,特异度为76.7%。结论: 血清可溶性PD-1表达在ICU肺结核死亡患者中明显升高,对评估入住ICU的肺结核患者的病情程度及预后具有一定的临床价值。

关键词: 重症监护病房, 结核, 肺, 程序性死亡受体-1, 预后

Abstract:

Objective: To evaluate the value of serum soluble programmed death receptor-1 (PD)-1 in assessing prognosis of the patients with pulmonary tuberculosis (PTB) in intensive care unit (ICU). Methods: A total of 102 pulmonary tuberculosis patients admitted to the ICU of Hebei Provincial Chest Hospital from April 2022 to April 2024 were included in this study, and they were divided into survival group and death group respectively, according to their survival status after 28 days in ICU. The serum soluble PD-1 levels of the patients in the two groups were compared, and its correlation with the severity, prognosis score and nutritional indicator of pulmonary tuberculosis patients in ICU was analyzed. Receiver operating characteristic (ROC) curve analysis was used to analyze the value of serum soluble PD-1 in assessing prognosis of the patients with pulmonary tuberculosis in ICU. Results: Among the 102 pulmonary tuberculosis patients in ICU who were included in this study, 42 patients died (death group) with the case fatality rate of 41.2% (42/102), and 60 patients survived (survival group) with the survival rate of 58.8% (60/102). Compared with the patients in the survival group, the serum PD-1 level increased significantly among those patients in the death group (PD-1 (pg/ml): 47.25 (41.48, 51.15) vs. 35.45 (28.40, 41.80), Z=―6.399, P<0.001). PD-1 level was positively correlated with APACHE Ⅱ and SOFA scores (r=0.580, P<0.001; r=0.575, P<0.001), negatively correlated with prealbumin level (r=―0.297, P=0.002), and not correlated with lactate level (r=0.104, P=0.297). The results of ROC curve analysis showed that the area under the ROC curve (AUC) of PD-1 in predicting death of pulmonary tuberculosis patients after entering ICU 28 days was 0.873 (95%CI: 0.809-0.938). The optimal cutoff value of serum PD-1 was 38.45 pg/ml, with the sensitivity and the specificity were 95.2% and 65.0% respectively. While PD-1 value was combined with APACHE Ⅱ, the sensitivity was more than 99.9% and the specificity was 76.7%. Conclusion: The serum soluble PD-1 level is significantly increased in the death patients with pulmonary tuberculosis in ICU. Serum soluble PD-1 has certain clinical value in evaluating the severity and prognosis of tuberculosis patients admitted to the ICU.

Key words: Intensive care units, Tuberculosis, pulmonary, Programmed cell death 1 receptor, Prognosis

中图分类号:

R521

魏云霞, 王鑫, 林红霞, 李义帅. 血清可溶性程序性死亡受体1与重症监护病房中肺结核患者病情及预后的关系研究[J]. 结核与肺部疾病杂志, 2025, 6(4): 426-431. doi: 10.19983/j.issn.2096-8493.20250032

Wei Yunxia, Wang Xin, Lin Hongxia, Li Yishuai. Study on the correlation between serum soluble PD-1 and the severity and prognosis of pulmonary tuberculosis patients in ICU[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(4): 426-431. doi: 10.19983/j.issn.2096-8493.20250032

图/表 4

表1

生存组与死亡组患者一般资料比较

指标	生存组(60例)	死亡组(42例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	63.00(58.00,70.25)	64.00(60.00,72.50)	Z=―0.885	0.376
性别[例,构成比(%)]			χ²=0.797	0.372
男性	44(73.33)	34(80.95)
女性	16(26.67)	8(19.05)
体质量指数(kg/m², $x ˉ$ ±s)	23.50±4.39	22.48±3.46	t=1.256	0.212
平均动脉压(mmHg, $x ˉ$ ±s)	85.63±13.60	80.38±13.34	t=1.933	0.056
心率[次/min,M(Q₁,Q₃)]	92.50(82.50,102.75)	96.50(89.00,111.75)	Z=―1.990	0.047

表1

表2

生存组与死亡组患者血清可溶性程序性死亡受体1水平及病情程度相关指标的比较

指标	生存组(60例)	死亡组(42例)	统计检验值	P值
氧合指数[mmHg,M(Q₁,Q₃)]	167.50(145.33,193.15)	147.90(118.15,176.44)	Z=―3.295	0.001
乳酸[mmol/L,M(Q₁,Q₃)]	1.30(0.90,1.78)	1.60(1.08,2.65)	Z=―1.696	0.090
白细胞计数[×10⁹/L,M(Q₁,Q₃)]	8.89(7.34,11.77)	10.26(6.35,14.91)	Z=1.176	0.239
前白蛋白[g/L,M(Q₁,Q₃)]	93.25(72.18,112.30)	76.85(59.13,133.20)	Z=―2.091	0.037
程序性死亡受体-1[pg/ml,M(Q₁,Q₃)]	35.45(28.40,41.80)	47.25(41.48,51.15)	Z=―6.399	<0.001
APACHEⅡ评分(分, $x ˉ$ ±s)	24.93±4.67	35.38±5.35	t=―10.479	<0.001
序贯器官衰竭评分[分,M(Q₁,Q₃)]	7.50(6.00,9.00)	12.00(10.75,14.00)	Z=―7.073	<0.001

表2

表3

可溶性程序性死亡受体1与重症监护病房肺结核患者28d预后的二元logistic回归分析结果

指标	β值	s $x ˉ$ 值	Wald χ²值	OR值	95%CI值		P值
指标	β值	s $x ˉ$ 值	Wald χ²值	OR值	下限	上限	P值
心率	0.023	0.030	0.581	1.023	0.965	1.084	0.446
氧合指数	―0.021	0.016	1.746	0.979	0.949	1.010	0.186
前白蛋白	―0.018	0.012	2.145	0.982	0.958	1.006	0.143
程序性死亡受体-1	0.182	0.083	4.822	1.199	1.020	1.411	0.028
APACHEⅡ评分	0.303	0.133	5.209	1.354	1.044	1.757	0.022
序贯器官衰竭评分	0.510	0.223	5.236	1.666	1.076	2.579	0.022

表3

图1

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