血清RIP3、TLR9水平在预测老年重症肺炎患者预后中的临床价值OA
Clinical value of serum RIP3 and TLR9 levels in predicting the prognosis of elderly patients with severe pneumonia
目的 探讨血清受体相互作用蛋白3(RIP3)、Toll样受体9(TLR9)水平在预测老年重症肺炎患者预后中的临床价值.方法 选取2022年10月—2024年12月北京市大兴区人民医院收治的228例老年重症肺炎患者,根据出院时预后分为预后良好组(n=170)与预后不良组(n=58).比较2组患者血清RIP3、TLR9水平以及基线资料的差异.采用受试者工作特征(ROC)曲线分析血清RIP3、TLR9水平对老年重症肺炎患者预后的预测价值,采用多因素logistic逐步回归分析探讨老年重症肺炎患者预后的影响因素.结果 预后不良组患者血清RIP3、TLR9水平均高于预后良好组,差异均有统计学意义(P<0.05).ROC曲线分析结果显示,血清 RIP3、TLR9预测老年重症肺炎患者预后的曲线下面积(AUC)分别为0.716(95%CI:0.671～0.766)和0.829(95%CI:0.784～0.879);二者联合(串联)预测的 AUC为0.902(95%CI:0.857～0.952),高于血清RIP3、TLR9单独预测(Z=8.162、10.328,P<0.05).预后不良组患者急性生理学和慢性健康状况Ⅱ(APACHE Ⅱ)评分、多器官功能障碍综合征(MODS)评分及有饮酒史、机械通气、体内留置导管占比高于预后良好组,差异均有统计学意义(P<0.05).多因素分析结果显示,APACHE Ⅱ评分(OR=1.998,95%CI:1.179～3.385),MODS评分(OR=1.964,95%CI:1.087～3.550),血清RIP3(OR=3.102,95%CI:1.802～5.338),血清TLR9(OR=2.956,95%CI:1.880～4.650)是老年重症肺炎患者预后的影响因素(P<0.05).结论 血清 RIP3和 TLR9水平升高与老年重症肺炎患者不良预后密切相关,二者联合检测能提升对患者不良预后的预测效能,具有重要临床价值.
Objective To investigate the clinical value of serum receptorinteracting protein 3(RIP3)and Tolllike receptor 9(TLR9)levels in predicting the prognosis of elderly patients with severe pneumonia.Methods A total of 228 elderly pa-tients with severe pneumonia admitted to Beijing Daxing District People's Hospital from October 2022 to December 2024 were selected and assigned to a good prognosis group(n=170)and a poor prognosis group(n=58)according to their dis-charge outcomes.The serum RIP3 and TLR9 levels and baseline data were compared between the two groups.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum RIP3 and TLR9 levels for the prog-nosis of elderly patients with severe pneumonia,and multivariate logistic stepwise regression analysis was used to identify the influencing factors for prognosis.Results The serum RIP3 and TLR9 levels in the poor prognosis group were signifi-cantly higher than those in the good prognosis group(P<0.05).ROC curve analysis showed that the AUCs of serum RIP3 and TLR9 for predicting prognosis were 0.716(95%CI:0.671-0.766)and 0.829(95%CI:0.784-0.879),respective-ly.The AUC of the combined detection was 0.902(95%CI:0.857-0.952),which was higher than that of serum RIP3 or TLR9 alone(Z=8.162,10.328;P<0.05).The Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Multiple Organ Dysfunction Syndrome(MODS)score,and the proportions of patients with a history of alcohol con-sumption,mechanical ventilation,and indwelling catheter in the poor prognosis group were higher than those in the good prognosis group,with statistically significant differences(P<0.05).Multivariate analysis showed that APACHE Ⅱ score(OR=1.998,95%CI:1.179-3.385),MODS score(OR=1.964,95%CI:1.087-3.550),serum RIP3(OR=3.102,95%CI:1.802-5.338),and serum TLR9(OR=2.956,95%CI:1.880-4.650)were influencing factors for the prog-nosis of elderly patients with severe pneumonia(P<0.05).Conclusion Elevated serum RIP3 and TLR9 levels are closely correlated with poor prognosis in elderly patients with severe pneumonia,and their combined detection can improve the pre-dictive efficacy for adverse outcomes,demonstrating important clinical value.
紫士怡;高原;杨佳靓;于伟;张燕;季家希;信维娜;王雪琳
首都医科大学大兴教学医院/北京市大兴区人民医院ICU,北京 102600首都医科大学大兴教学医院/北京市大兴区人民医院ICU,北京 102600首都医科大学大兴教学医院/北京市大兴区人民医院ICU,北京 102600首都医科大学大兴教学医院/北京市大兴区人民医院心内科,北京 102600首都医科大学大兴教学医院/北京市大兴区人民医院ICU,北京 102600首都医科大学大兴教学医院/北京市大兴区人民医院ICU,北京 102600首都医科大学大兴教学医院/北京市大兴区人民医院ICU,北京 102600首都医科大学附属北京同仁医院RICU,北京 100730
医药卫生
重症肺炎老年患者受体相互作用蛋白3Toll样受体9预后预测效能
Severe pneumoniaElderly patientsReceptorinteracting protein 3Tolllike receptor 9PrognosisPredictive ef-ficacy
《保健医学研究与实践》 2026 (3)
62-68,7
首都卫生发展科研专项项目(首发2022-3-7122).
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