可溶性人基质裂解素2(sST2)在CAP血清中的表达及临床意义

doi:10.3877/cma.j.issn.1674-6902.2023.06.005

目的

分析可溶性人基质裂解素2(soluble suppression of tumorigenicity 2, sST2)社区获得性肺炎(community-acquired pneumonia, CAP)血清中的表达及临床意义。

方法

选择2023年4月至2023月7月我院收治的56例CAP患者为对象，预后恢复临床稳定性41例为对照组，未恢复临床稳定性15例为观察组。检测sST2水平，收集性别、年龄、吸烟史、白细胞计数(leukocyte count, WBC)、中性粒细胞(neutrophil, Neu)、淋巴细胞(lymphocyte, Lym)、C反应蛋白(C reactive protein, CRP)、N-末端脑利钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)、降钙素原(procalcitonin, PCT)临床资料，采用多因素Logistics回归分析临床稳定性的影响因素，绘制ROC曲线分析sST2水平对临床稳定性。

结果

观察组年龄(59.88±9.20)岁、CRP(53.15±10.24) mg/ml、PCT(1.20±0.24 )ng/ml及sST2(73.61±8.16)ng/ml、PSI分级Ⅳ～Ⅴ10例(66.67%)高于对照组年龄(54.10±9.16)岁、CRP(12.30±2.16)mg/ml、PCT(0.08±0.02 )ng/ml及sST2(64.87±6.25)ng/ml和PSI分级Ⅳ～Ⅴ15例(36.59%)(P<0.05)。多因素Logistics回归分析显示，CRP(OR＝1.042)、PCT(OR＝0.682)及sST2(OR＝0.848)是CAP患者临床稳定性的影响因素(P<0.05)。ROC曲线结果显示sST2水平AUC＝0.815，95%CI：0.688～0.906；CRP水平AUC＝0.733，95%CI：0.598～0.843；PCT水平AUC＝0.798，95%CI：0.709～0.870。

结论

CAP sST2水平升高；入院时sST2水平可作为预测CAP恢复临床稳定性的生物标志物。

关键词: 可溶性人基质裂解素2, 社区获得性肺炎, C反应蛋白, 降钙素原, 预测价值

Objective

To analyze the expression and clinical significance of soluble human matrix lysate 2 (sST2) in serum of patients with community-acquired pneumonia (CAP).

Methods

All of 56 patients with community-acquired pneumonia (CAP) admitted to our hospital from April 2023 to July 2023 were included as the research group, and 41 cases of clinical stability recovery were divided into control group and 15 cases of clinical stability recovery were observed group. The patient′s sST2 level was detected, and the general data such as gender, age and smoking history and clinical data, including white blood cell count (WBC), neutrophil (Neu), lymphocyte (Lym), C-reactive protein (CRP), N- terminal pro-brain natriuretic peptide (NT-proBNP), and so on, were collected by using electronic medical records. Multivariate logistics regression was used to analyze the influencing factors of clinical stability, and the ROC curve was drawn to analyze the predictive value of sST2 level on clinical stability.

Results

The age (59.88±9.20) years old, CRP (53.15±10.24 )mg/ml, PCT(1.20±0.24 )ng/ml, sST2(73.61±8.16)ng/ml, PSI grade Ⅳ~Ⅴ in 10 cases (66.67%) in observation group were higher than those in control group (54.10±9.16 )years old, CRP(12.30±2.16)mg/ml, PCT(0.08±0.02) ng/ml, sST2(64.87±6.25)ng/ml and PSI classification Ⅳ~Ⅴ (P<0.05) in 10 cases (66.67%). Multivariate logistics regression analysis showed that CRP(OR=1.042), PCT(OR=0.682) and sST2(OR=0.848) were the influencing factors for the clinical stability of elderly CAP patients (P<0.05). The ROC curve shows that AUC of sST2 level is 0.815, and 95%CI is 0.688-0.906. The AUC of CRP level was 0.733, and 95%CI was 0.598-0.843. The AUC of PCT level is 0.798, and 95%CI was 0.709-0.870.

Conclusion

The level of sST2 in CAP patients is significantly higher. The level of sST2 at admission can be used as a biomarker to predict the recovery of clinical stability in CAP patients.

Key words: Soluble human matrix lysin 2, Community-acquired pneumonia, C-reactive protein, Procalcitonin, Predicted value

表1 两组患者临床资料比较(±s)

临床资料	对照组(n＝41)	观察组(n＝15)	t/U/χ²值	P值
性别(男/女)	23/18	11/4	1.368	0.242
年龄(岁)	54.10±9.16	59.88±9.20	2.084	0.048
吸烟史[n(%)]	13(31.71)	5(33.33)	0.013	0.908
BMI值(kg/m²)	23.04±6.81	21.78±6.78	0.615	0.544
PSI分级[n(%)]			4.021	0.045
Ⅱ～Ⅲ	26(63.41)	5(33.33)
Ⅳ～Ⅴ	15(36.59)	10(66.67)
WBC(×10⁹/L)	9.30±1.47	10.19±1.53	1.948	0.063
Neu(%)	79.10±10.06	85.61±12.24	1.845	0.079
Lym(%)	12.07±2.15	10.78±2.23	1.935	0.065
CRP(mg/ml)	12.30±2.16	53.15±10.24	15.326	0.000
NT-proBNP(pg/ml)	4 749.95±521.26	5 106.02±617.34	1.989	0.060
PCT(ng/ml)	0.08±0.02	1.20±0.24	18.051	0.000
sST2(ng/ml)	64.87±6.25	73.61±8.16	3.764	0.001

表1 两组患者临床资料比较(±s)

临床资料	对照组(n＝41)	观察组(n＝15)	t/U/χ²值	P值
性别(男/女)	23/18	11/4	1.368	0.242
年龄(岁)	54.10±9.16	59.88±9.20	2.084	0.048
吸烟史[n(%)]	13(31.71)	5(33.33)	0.013	0.908
BMI值(kg/m²)	23.04±6.81	21.78±6.78	0.615	0.544
PSI分级[n(%)]			4.021	0.045
Ⅱ～Ⅲ	26(63.41)	5(33.33)
Ⅳ～Ⅴ	15(36.59)	10(66.67)
WBC(×10⁹/L)	9.30±1.47	10.19±1.53	1.948	0.063
Neu(%)	79.10±10.06	85.61±12.24	1.845	0.079
Lym(%)	12.07±2.15	10.78±2.23	1.935	0.065
CRP(mg/ml)	12.30±2.16	53.15±10.24	15.326	0.000
NT-proBNP(pg/ml)	4 749.95±521.26	5 106.02±617.34	1.989	0.060
PCT(ng/ml)	0.08±0.02	1.20±0.24	18.051	0.000
sST2(ng/ml)	64.87±6.25	73.61±8.16	3.764	0.001

表2 临床稳定性多因素Logistic回归分析

临床指标	β	S.E	Wald	P值	OR	95%CI
年龄	－0.257	0.139	3.434	0.064	0.773	0.589～1.105
PSI分级	2.527	1.792	1.989	0.158	12.514	0.374～19.293
CRP	0.041	0.024	2.901	0.039	1.042	0.994～1.091
PCT	－0.383	0.173	4.876	0.027	0.682	0.486～0.958
sST2	－0.165	0.068	5.960	0.015	0.848	0.743～0.968

表2 临床稳定性多因素Logistic回归分析

临床指标	β	S.E	Wald	P值	OR	95%CI
年龄	－0.257	0.139	3.434	0.064	0.773	0.589～1.105
PSI分级	2.527	1.792	1.989	0.158	12.514	0.374～19.293
CRP	0.041	0.024	2.901	0.039	1.042	0.994～1.091
PCT	－0.383	0.173	4.876	0.027	0.682	0.486～0.958
sST2	－0.165	0.068	5.960	0.015	0.848	0.743～0.968

表3 sST2、CRP及PCT水平的ROC曲线预测

指　标	AUC	95%CI	敏感性(%)	特异性(%)
sST2	0.815	(0.688～0.906)	85.37	80.00
CRP	0.733	(0.598～0.843)	80.49	66.67
PCT	0.798	(0.709～0.870)	85.19	75.95

表3 sST2、CRP及PCT水平的ROC曲线预测

指　标	AUC	95%CI	敏感性(%)	特异性(%)
sST2	0.815	(0.688～0.906)	85.37	80.00
CRP	0.733	(0.598～0.843)	80.49	66.67
PCT	0.798	(0.709～0.870)	85.19	75.95

1	刘　熙，李　琦. 我国成人社区获得性肺炎诊疗现状及思考[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(3): 387-389.
2	李晓梅，史亮亮，张　瑶，等. 中国老年社区获得性肺炎现状[J]. 空军军医大学学报，2022, 43(7): 910-913.
3	Wang J, Song YL. Advances in severe community-acquired pneumonia[J]. Chin Med J (Engl), 2019, 132(16): 1891-1893.
4	徐俊利，代宝春，闫永杰，等. 血清维生素D、IL-6、正五聚蛋白3、N末端脑钠肽前体与社区获得性肺炎患者病情严重程度的关系及其对预后的预测价值[J]. 实用心脑肺血管病杂志，2023, 31(5): 50-54.
5	Zhao T, Zheng Y, Hao D, et al. Blood circRNAs as biomarkers for the diagnosis of community-acquired pneumonia[J]. J Cell Biochem, 2019, 120(10): 16483-16494.
6	Villacorta H, Maisel AS. Soluble ST2 testing: A promising biomarker in the management of heart failure[J]. Arq Bras Cardiol, 2016, 106(2): 145-152.
7	Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2013, 62(16): e147-239.
8	王燕慧，李　梁，陶应敏，等. 血清可溶性生长刺激表达基因2蛋白、半乳糖凝集素-3、NT-proBNP在老年心力衰竭患者预后中的研究[J]. 老年医学与保健，2022, 28(2): 257-262.
9	Watanabe M, Nakamoto K, Iuui T, et al. Serum sST2 levels predict severe exacerbation of asthma[J]. Respir Res, 2018, 19(1): 169.
10	Xia J, Zhao J, Shang J, et al. Increased IL-33 expression in chronic obstructive pulmonary disease[J]. Am J Physiol Lung Cell Mol Physiol, 2015, 308(7): 619-627.
11	Usuda D, Sangen R, Hashimoto Y, et al. Validation of a B-type natriuretic peptide as a prognostic marker in pneumonia patients: a prospective cohort study[J]. BMJ Open, 2016, 6(2): e010440.
12	Miyazaki H, Nagata N, Akagi T, et al. Comprehensive analysis of prognostic factors in hospitalized patients with pneumonia occurring outside hospital: Serum albumin is not less important than pneumonia severity assessment scale[J]. J Infect Chemother, 2018, 24(8): 602-609.
13	Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America[J]. Am J Respir Crit Care Med, 2019, 200(7): e45-e67.
14	Blum CA, Nigro N, Briel M, et al. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial[J]. Lancet, 2015, 385(9977): 1511-1518.
15	Chen WY, Tsai TH, Yang JL, et al. Therapeutic strategies for targeting IL-33/ST2 signalling for the treatment of inflammatory diseases[J]. Cell Physiol Biochem, 2018, 49(1): 349-358.
16	陶静秋，陈正进，杨　猛，等. PDCA理论优化COPD社区管理路径的构建及其对COPD患者血清IL-33水平、肺功能及生活质量的影响[J]. 国际免疫学杂志，2022, 45(6): 597-602.
17	Homsak E, Gruson D. Soluble ST2: A complex and diverse role in several diseases[J]. Clin Chim Acta, 2020, 507: 75-87.
18	Mueller T, Jaffe AS. Soluble ST2-analytical considerations[J]. Am J Cardiol, 2015, 115(7 Suppl): 8B-21B.
19	Xia N, Lu Y, Gu M, et al. A unique population of regulatory T cells in heart potentiates cardiac protection from myocardial infarction[J]. Circulation, 2020, 142(20): 1956-1973.
20	Griesenauer B, Paczesny S. The ST2/IL-33 Axis in Immune Cells during Inflammatory Diseases[J]. Front Immunol, 2017, 8(1): 475.
21	Gimenes J A Jr, Srivastava V, Reddyvari H, et al. Rhinovirus-induces progression of lung disease in a mouse model of COPD via IL-33/ST2 signaling axis[J]. Clin Sci (Lond), 2019, 133(8): 983-996.
22	陶学娇，卢均坤，陈嘉辉，等. FIB-4、sST2水平与心力衰竭及其严重程度的相关性分析[J]. 新医学，2023, 54(8): 569-573.
23	Zhang T, Zeng Y, Lin R, et al. Incorporation of suppression of tumorigenicity 2 into random survival forests for enhancing prediction of short-term prognosis in community-ACQUIRED pneumonia[J]. J Clin Med, 2022, 11(20): 6015.
24	Kamat IS, Ramachandran V, Esearan H, et al. Procalcitonin to distinguish viral from bacterial pneumonia: A systematic review and Meta-analysis[J]. Clin Infect Dis, 2020, 70(3): 538-542.
25	陈　惠. C反应蛋白及降钙素原与老年哮喘合并社区获得性肺炎的相关性及其特异性诊断价值[J]. 国际老年医学杂志，2022, 43(3): 284-287.
26	Avari M, Brown JS. Management of community-acquired pneumonia：essential tips for the physician on call[J]. Br J Hosp Med (Lond), 2020, 81(5): 1-9.
27	田　欣. APACHE Ⅱ评分联合动脉血乳酸清除率、降钙素原对重症肺炎患者预后的判断价值[D]. 华北理工大学，2021.
28	Self WH, Balk RA, Grijalva CG, et al. Procalcitonin as a marker of etiology in adults hospitalized with community-acquired pneumonia[J]. Clin Infect Dis, 2017, 65(2): 183-190.
29	Ruiz-Castilla M, Dos Santos B, Vizcaino C, et al. Soluble suppression of tumorigenicity-2 predicts pneumonia in patients with inhalation injury: Results of a pilot study[J]. Burns, 2021, 47(4): 906-913.
30	Kearley J, Silver JS, Sanden C, et al. Cigarette smoke silences innate lymphoid cell function and facilitates an exacerbated type I interleukin-33-dependent response to infection[J]. Immunity, 2015, 42(3): 566-579.

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Expression and clinical significance of soluble human stromelysin 2(sST2) in serum of patients with pneumonia

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Expression and clinical significance of soluble human stromelysin 2(sST2) in serum of patients with pneumonia