【摘要】 目的 探讨血清淀粉样蛋白A(serum amyloid A protein, SAA)、降钙素原(procalcitonin, PCT)、Treg细胞及有关因子在多重耐药菌(multidrug-resisitant organism, MDRO)肺炎感染患者中的表达水平及其与疗效的关联性。方法 选取97例MDRO肺炎感染患者为研究对象，根据治疗14 d后的治疗效果分为有效组(73例)和无效组(24例),根据入院时肺炎严重指数(PSI)分为低危(34例)、中危(49例)、高危(14例)三个亚组。比较2组治疗前、治疗7 d后、治疗14 d后SAA、PCT、Treg细胞、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平，比较治疗前低危、中危、高危患者血清各指标水平及PSI评分，分析血清各指标水平与PSI评分的相关性。结果 与无效组比较，治疗7、14 d后有效组SAA、PCT、hs-CRP、TNF-α水平较低，Treg细胞数较高，差异有统计学意义(P<0.05);治疗前，低危患者SAA、PCT、hs-CRP、TNF-α及PSI评分<中危患者<高危患者，Treg细胞数>中危患者>高危患者，差异有统计学意义(P<0.05);治疗前，SAA、PCT、hs-CRP、TNF-α水平与PSI评分呈正相关，Treg细胞数与PSI评分呈负相关(P<0.05);受试者操作特征(ROC)曲线显示治疗前SAA、PCT、Treg细胞、hs-CRP、TNF-α联合预测治疗无效的AUC大于各指标单独预测。结论 MDRO肺炎感染患者SAA、PCT、hs-CRP、TNF-α、Treg细胞数量呈异常表达，且表达水平对预后具有重要影响，临床可监测其水平变化，联合预测预后的价值较高。更多还原

【Abstract】 Objective To investigate the expression levels of serum amyloid A protein(SAA), procalcitonin(PCT), Treg cells and related factors in patients with multidrug-resistant organism(MDRO) pneumonia infection and the related correlation with efficacy. Methods Ninety-seven patients with MDRO pneumonia infection were selected for the study and were divided into an effective group(73 patients) and an ineffective group(24 patients) based on the therapeutic efficacy after 14 d of treatment. All patients were categorized into three subgroups based on the pneumonia severity index(PSI) at the time of admission: low-risk(34 patients), intermediate-risk(49 patients) and high-risk(14 patients) group. In this study, the levels of SAA, PCT, Treg cells, ultrasensitive C-reactive protein(hs-CRP) and tumour necrosis factor-α(TNF-α) were compared between the two groups before treatment and after 7 d and 14 d of treatment. At the same time, the serum index levels and PSI scores of low-risk, intermediate-risk and high-risk patients were compared before and after treatment, and the related correlation of above-mentioned indicators was analyzed. Results Compared with the ineffective group, SAA, PCT, hs-CRP and TNF-α levels were lower and Treg cell count was higher in the effective group after 7 and 14 d of treatment(P<0.05). Before treatment, SAA, PCT, hs-CRP, TNF-α levels and PSI scores gradually increased in low-, intermediate-and high-risk patients; while Treg cell counts gradually decreased, with statistically significant differences(P<0.05). Before treatment, the levels of SAA, PCT, hs-CRP, and TNF-α were positively correlated with the PSI score, and the number of Treg cells was negatively correlated with the PSI score(P<0.05). Subject operating characteristic(ROC) curves showed that the AUC of combining SAA, PCT, Treg cells, hs-CRP and TNF-α to predict treatment inefficacy was greater than each individual indicator. Conclusion SAA, PCT, hs-CRP, TNF-α and Treg cell counts can be abnormally expressed in patients with MDRO pneumonia infection, and the expression levels have an important effect on prognosis. Therefore, the clinic can monitor the changes of the levels, and the combined indicators have a high value in predicting prognosis.更多还原