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投稿时间：2024-08-05 网络发布日期：2025-11-26
投稿时间：2024-08-05 网络发布日期：2025-11-26
中文摘要: 目的 探究血清活性蛋白C（APC）和4-羟基壬烯醛（4-HNE）在重症肺炎患者中的水平变化，并分析它们与患者转归和心肌损伤之间的相关性。方法 随机选择2023年9月到2024年4月在南京医科大学第四附属医院住院的86例肺炎患者作为研究对象，其中重症肺炎59例，非重症肺炎27例。收集其临床资料及实验室指标，包括年龄、性别、病史、病情严重程度评分、心肌损伤标志物［肌红蛋白（Mb）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）］等。采用酶联免疫吸附法（ELISA）检测患者血清中的APC和4-HNE水平，logistic回归模型分析影响重症肺炎患者的预后因素。结果 与非重症肺炎组相比，重症肺炎组血清 APC［（98.18±23.04）pg/mL vs（53.32±33.08）pg/mL，t=6.374，P<0.01］、4-HNE［（143.41±44.55）pg/mL vs（81.65±19.80）pg/mL，t=8.900，P<0.01］水平更高。Pearson相关分析显示，血清APC水平与机械通气时间呈正相关（r=0.514，P<0.01）；Spearman相关分析显示，血清APC和4-HNE水平与28 d病死率呈正相关（P<0.05）。多因素logistic回归分析显示，APC和4-HNE增高，单核细胞人类白细胞DR抗原（HLA-DR）/CD14+降低是重症肺炎患者预后的独立危险因素（P<0.05）。受试者工作特征（ROC）曲线分析显示，APC、4-HNE、HLA-DR+/CD14+预测重症肺炎患者死亡的 ROC 曲线下面积（AUC）分别为0.878、0.865和0.828。结论 血清APC和4-HNE可作为重症肺炎诊断的早期生物标志物。早期高APC水平和4-HNE水平可用于预测患者的临床转归及心肌损伤风险。
中文关键词: 重症肺炎 活性蛋白C 4⁃羟基壬烯醛 人类白细胞DR抗原/CD14+ 心肌损伤
Abstract:Objective To investigate the changes of serum activated protein C（APC）and 4 - hydroxynonenal（4 - HNE）levels in patients with severe pneumonia，and analyze their correlation with patient outcomes and myocardial injury. Methods A total of 86 pneumonia patients hospitalized in the Fourth Affiliated Hospital of Nanjing Medical University from September 2023 to April 2024 were randomly selected as study subjects，including 59 cases of severe pneumonia and 27 cases of non-severe pneumonia. Clinical data and laboratory indicators such as age，gender，medical history，severity scores，and myocardial injury markers［myoglobin（Mb），cardiac troponin I（cTnI），creatine kinase isoenzyme（CK-MB）］were collected. Enzyme-linked immunosorbent assay（ELISA）was used to detect the levels of APC and 4-HNE in the serum of all patients. Logistic regression model was used to analyze the influencing factors on prognosis of patients with severe pneumonia. Results The levels of serum APC［（98.18±23.04）pg/mL vs（53.32±33.08）pg/mL，t=6.374，P<0.01］and 4-HNE［（143.41±44.55）pg/mL vs（81.65±19.80）pg/mL，t=8.900，P<0.01］in the severe pneumonia group were higher than those in the non-severe pneumonia group，with statistically significant differences. Pearson correlation analysis showed that serum APC levels were positively correlated with mechanical ventilation time（r=0.514，P<0.01）. Spearman correlation analysis indicated that levels of serum APC and 4 - HNE were positively correlated with 28 - day mortality（P<0.05）. Multivariate logistic regression analysis revealed that increased APC，4 - HNE，and reduced HLA- DR +/CD14 + were independent risk factors for the prognosis of severe pneumonia patients（P<0.05）. Receiver operating characteristic（ROC）curve analysis showed that the area under the curve（AUCs）of APC，4-HNE，and HLA-DR+/CD14+ for predicting prognosis in patients with severe pneumonia were 0.878，0.865，and 0.828，respectively. Conclusion Serum APC and 4 - HNE can serve as biomarkers for early diagnosis in patients with severe pneumonia. Elevated levels of APC and 4-HNE at early stage can be used to predict clinical outcomes and the risk of myocardial injury.
keywords: Severe pneumonia Activated protein C 4⁃hydroxynonenal Human leukocyte antigen⁃DR/CD14+ Myocardial injury
文章编号： 中图分类号：R563.1 文献标志码：A
基金项目:南京医科大学科技发展基金项目（NMUB20230039）；南京医科大学第四附属医院院级人才青年探索项目（23YJRC24）
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引用文本：
高田,王巍,王玲,等.血清活性蛋白C及4⁃羟基壬烯醛水平与重症肺炎心肌损伤的相关性及对其转归的预测[J].中国临床研究,2025,38(11):1746-1750.
高田,王巍,王玲,等.血清活性蛋白C及4⁃羟基壬烯醛水平与重症肺炎心肌损伤的相关性及对其转归的预测[J].中国临床研究,2025,38(11):1746-1750.