【摘要】 目的 探讨血清降钙素原（PCT）、可溶性髓样细胞触发受体-1（sTREM-1）、S100钙结合蛋白A9（S100A9）表达水平与老年心力衰竭（HF）合并肺部感染患者心功能的关系,及其对预后的影响。方法 选择2020年1月-2022年1月青海大学附属医院收治的老年HF合并肺部感染患者171例为感染组,另随机选取同期收治的单纯HF患者106例为未感染组。感染组根据预后分为预后不良组（n=36）和预后良好组（n=135）。比较感染组与未感染组、预后良好组与预后不良组血清PCT、sTREM-1、S100A9水平及左心室射血分数（LVEF）、心电图QRS波群时限（QRSd）、LVEF/QRSd比值。分析PCT、sTREM-1、S100A9与LVEF、QRSd、LVEF/QRSd的相关性,采用单因素及多因素logistic回归分析老年HF合并肺部感染预后不良的危险因素,采用受试者工作特征（ROC）曲线分析血清PCT、sTREM-1、S100A9对老年HF合并肺部感染患者预后不良的预测价值。结果 感染组、预后不良组血清PCT、sTREM-1、S100A9及QRSd水平高于未感染组、预后良好组,差异均有统计学意义（t=-27.483、-19.304、-25.813、-9.103,t=-8.328、-8.258、-8.675、-10.490,P均<0.05）,LVEF、LVEF/QRSd低于未感染组、预后良好组,差异均有统计学意义（t=17.908、19.414,t=10.479、15.112,P均<0.05）。老年HF合并肺部感染患者血清PCT、sTREM-1、S100A9与QRSd成正相关（r=0.622、0.633、0.626,P均<0.05）,与LVEF、LVEF/QRSd比值成负相关(r_LVEF=-0.617、-0.604、-0.648, r_LVEF/QRSd=-0.655,-0.665,-0.692,P均<0.05)。血清PCT、sTREM-1、S100A9、B型利钠肽（BNP）、LVEF/QRSd、美国纽约心脏病学会（NYHA）心功能分级Ⅲ～Ⅳ级是老年HF合并肺部感染患者预后的影响因素（P均<0.05）。血清PCT、sTREM-1、S100A9及三者联合检测预测老年HF合并肺部感染患者预后不良的曲线下面积（AUC）分别为0.847、0.839、0.863、0.969。结论 老年HF合并肺部感染患者血清PCT、sTREM-1、S100A9水平与心功能及预后有密切的相关性,早期检测血清PCT、sTREM-1、S100A9对老年HF合并肺部感染患者预后具有较高的预测价值。更多还原

【Abstract】 Objective To explore the relationship between serum procalcitonin（PCT）, soluble triggering receptor expressed on myeloid cells-1（sTREM-1）, S100 calcium-binding protein A9（S100A9） and cardiac function and prognosis in elderly patients with heart failure（HF） combined with pulmonary infection. Methods A total of 171 elderly patients with HF combined with pulmonary infection who were admitted to the Qinghai University Affiliated Hospital from January 2020 to January 2022 were selected as infection group, and 106 patients with HF without infection during the same period were randomly selected as non-infection group. Infection group was divided into poor prognosis group（36 cases） and good prognosis group（135 cases） based on the prognosis. The serum PCT, sTREM-1 and S100A9 levels, left ventricular ejection fraction（LVEF）, QRS complex duration（QRSd）, and LVEF/QRSd ratio were compared between infection group and non-infection group, as well as between good prognosis group and poor prognosis group. The correlation between PCT, sTREM-1,S100A9 and LVEF, QRSd and LVEF/QRSd were analyzed; the risk factors of poor prognosis in elderly patients with HF combined with pulmonary infection were analyzed by univariate and multivariate logistic regression, and the predictive value of serum PCT, sTREM-1, S100A9, and their combined detection for predicted poor prognosis in elderly patients with HF combined with pulmonary infection was analyzed by the receiver operating characteristic（ROC） curve. Results The levels of serum PCT, sTREM-1, S100A9, and QRSd in infection group, poor prognosis group were significantly higher than those in non-infection group, good prognosis group,the differences were statistically significant（t=-27.483,-19.304,-25.813,-9.103, t=-8.328,-8.258,-8.675,-10.490; all P<0.05）, and the LVEF and LVEF/QRSd ratio were significantly lower than those in non-infection group, poor prognosis group,the differences were statistically significant（t=17.908, 19.414, t=10.479, 15.112; all P<0.05）. There was a positive correlation between serum PCT, sTREM-1, S100A9 and QRSd in elderly patients with HF combined with pulmonary infection（r=0.622, 0.633, 0.626; all P<0.05）, and there was a negative correlation between them and LVEF and LVEF/QRSd ratio(r_LVEF=-0.617,-0.604,-0.648, r_LVEF/QRSd=-0.655,-0.665,-0.692; all P<0.05). Multivariate logistic regression analysis showed that serum PCT, sTREM-1, S100A9, B-type natriuretic peptide（BNP）, LVEF/QRSd ratio, and the American New York Heart Assocication（NYHA） cardiac function grade Ⅲ-Ⅳ were influencing factors of prognosis in elderly patients with HF combined with pulmonary infection（all P<0.05）. The area under the curve（AUC） of serum PCT, sTREM-1, S100A9, and their combined detection for predicted poor prognosis in elderly patients with HF combined with pulmonary infection were 0.847, 0.839, 0.863, and 0.969, respectively. Conclusions Serum PCT, sTREM-1, and S100A9 were closely correlated with cardiac function and prognosis in elderly patients with HF and pulmonary infection. Early detection of serum PCT, sTREM-1, and S100A9 levels had a high predictive value for the prognosis of elderly patients with HF and pulmonary infection.更多还原