肺泡灌洗液中IL-33表达水平对老年重症肺炎患者治疗28天死亡的预测价值

赵沙沙; 王鹏伟; 王圆圆; 冯宪军

doi:10.16766/j.cnki.issn.1674-4152.004163

肺泡灌洗液中IL-33表达水平对老年重症肺炎患者治疗28天死亡的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.004163

新乡医学院第一附属医院呼吸重症监护室，河南卫辉 453100

基金项目:

河南省医学科技攻关计划项目 LHGJ20210525

详细信息

通讯作者:
王鹏伟，E-mail: 563724898@qq.com

中图分类号: R563.1 R730.7
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出版历程
- 收稿日期: 2024-09-18
- 网络出版日期: 2025-11-17

Prognostic value of IL-33 expression in alveolar lavage fluid for predicting 28-day mortality in elderly patients with severe pneumonia

Respiratory ICU, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan 453100, China

摘要

摘要: 目的研究表明重症肺炎的炎症状态和血清中白细胞介素33(IL-33)水平密切相关，目前重症肺炎患者肺泡灌洗液中IL-33水平尚不清楚，本研究旨在探讨老年重症肺炎患者肺泡灌洗液中IL-33水平与预后的关系。方法纳入2021年1月—2023年12月新乡医学院第一附属医院呼吸重症监护室诊治的160例老年重症肺炎患者，根据治疗28 d后是否发生死亡分为存活组(117例)和死亡组(43例)。收集研究对象临床资料，采用ELISA法检测肺泡灌洗液中IL-33的表达水平。分析老年重症肺炎患者治疗28 d后死亡的影响因素，IL-33水平与患者急性生理和慢性健康状况Ⅱ评分(APACHE Ⅱ评分)的相关性采用Pearson法分析，采用ROC曲线分析IL-33水平预测老年重症肺炎患者治疗28 d死亡的临床效能。结果死亡组白细胞、中性粒细胞、超敏C反应蛋白、降钙素原、APACHE Ⅱ评分显著高于存活组，差异均有统计学意义(P < 0.05)。入院后，死亡组肺泡灌洗液中IL-33表达水平显著高于存活组(P < 0.001)。老年重症肺炎患者肺泡灌洗液中IL-33表达水平与APACHE Ⅱ评分呈正相关关系(r=0.671, P < 0.001)。降钙素原和肺泡灌洗液中IL-33为老年重症肺炎患者治疗后28 d死亡的影响因素。入院时老年重症肺炎患者肺泡灌洗液中IL-33表达预测患者治疗28 d后死亡的临床效能显著，预测灵敏度和特异度分别为89.45%、90.82%。结论老年重症肺炎患者肺泡灌洗液中IL-33表达水平显著升高，且IL-33可作为患者治疗28 d后发生死亡的一项标志物。
- 重症肺炎 /
- 白细胞介素33 /
- 肺泡灌洗 /
- 预后
Abstract: Objective Previous studies had shown a close association between the inflammatory status of severe pneumonia and serum interleukin 33 (IL-33) levels. However, the prognostic significance of IL-33 levels in alveolar lavage fluid was still unclear. This study aimed to investigate the relationship between expression levels of IL-33 in alveolar lavage fluid and 28-day mortality in elderly patients with severe pneumonia and its prognosis. Methods A total of 160 elderly patients with severe pneumonia admitted to the Respiratory ICU of the First Affiliated Hospital of Xinxiang Medical University between January 2021 and December 2023 were enrolled. Based on 28-day survival status, patients were divided into a survival group (n=117) and a death group (n=43). The clinical data of all individuals were collected, and the expression levels of IL-33 in alveolar lavage fluid were analyzed by ELISA methods. Pearson method was used to analyze the correlation between IL-33 levels and acute physiology and chronic health evaluation-Ⅱ score (APACHE Ⅱ) of elderly patients with severe pneumonia. The clinical efficacy of IL-33 levels in predicting 28-day mortality in elderly patients with severe pneumonia was analyzed by ROC curve. Results Compared with the survival group, the levels of leukocytes, neutrophils, hypersensitive C-reactive protein, procalcitonin, and APACHE Ⅱ in the death group were significantly increased than in the survival group, respectively (P < 0.05). The expression level of IL-33 in alveolar lavage fluid in the death group was significantly higher than that in the survival group (P < 0.001). The expression level of IL-33 in alveolar lavage fluid of elderly patients with severe pneumonia was positive correlated with APACHE Ⅱ score (r=0.671, P < 0.001). The procalcitonin and IL-33 in alveolar lavage fluid were identified as independent risk factors for 28-day treatment for severe pneumonia. The expression level of IL-33 in alveolar lavage fluid of elderly patients with severe pneumonia had a significant clinical efficacy in predicting 28-day mortality, with sensitivity and specificity of 89.45% and 90.82%, respectively. Conclusion The expression level of IL-33 in alveolar lavage fluid was significantly increased in elderly patients with severe pneumonia. IL-33 may serve as a biomarker for predicting 28-day mortality in this population.
- Severe pneumonia /
- Interleukin 33 /
- Alveolar lavage fluid /
- Prognosis

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图 1 肺泡灌洗液中IL-33水平预测老年重症肺炎患者治疗28 d死亡的ROC曲线

Figure 1. ROC curve of IL-33 level in alveolar lavage fluid for predicting the incidence of death after 28 days treatment in elderly patients with severe pneumonia

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表 1 存活组和死亡组老年重症肺炎患者一般资料的比较

Table 1. Comparison of general data of elderly patients with severe pneumonia between survival group and death group

项目	存活组(n=117)	死亡组(n=43)	统计量	P值
性别(男性/女性，例)	72/45	20/23	2.905^a	0.088
年龄(x±s，岁)	65.93±2.31	66.83±3.29	1.936^b	0.055
BMI(x±s)	27.19±3.02	26.43±2.71	1.449^b	0.149
体温(x±s，℃)	38.34±1.29	38.78±1.31	1.905^b	0.059
有吸烟史[例(%)]	31(26.50)	9(20.93)	0.519^a	0.471
有饮酒史[例(%)]	27(23.08)	8(18.60)	0.368^a	0.544
共患病[例(%)]
糖尿病	31(26.50)	15(34.88)	1.080^a	0.299
高血压	20(17.09)	13(30.23)	3.315^a	0.069
肺炎类型[例(%)]			0.116^a	0.734
细菌性/病毒性	101(86.32)	38(88.37)
其他	16(13.68)	5(11.63)
氧合指数(x±s，mmHg)	204.34±34.93	203.64±35.11	0.112^b	0.911
白细胞(x±s，×10⁹/L)	11.22±2.55	13.27±2.61	4.480^b	< 0.001
中性粒细胞(x±s，×10⁹/L)	6.85±1.34	9.11±1.56	9.040^b	< 0.001
超敏C反应蛋白(x±s，mg/L)	32.11±5.78	66.41±5.61	33.536^b	< 0.001
降钙素原(x±s，ng/mL)	0.71±0.12	1.28±0.21	21.406^b	< 0.001
APACHE Ⅱ评分(x±s，分)	17.92±2.04	24.23±3.45	14.188^b	< 0.001
注：^a为χ²值，^b为t值。1 mmHg=0.133 kPa。

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表 2 重症肺炎患者治疗后28 d死亡影响因素的logistic回归分析

Table 2. Logistic regression analysis of risk factors for death after 28 days treatment in patients with severe pneumonia

变量	B	SE	Waldχ²	P值	OR(95% CI)
降钙素原	0.851	0.531	2.566	0.001	2.341(1.123~4.781)
肺泡灌洗液中IL-33	1.063	0.412	6.657	< 0.001	2.895(1.221~6.031)
注：本表仅列出差异有统计学意义的变量。赋值方法如下，性别为男=1，女=0；吸烟史、饮酒史、合并糖尿病、合并高血压均为有=1，无=0；其余变量均以实际值赋值。

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