重症肺炎HE4表达水平及预后分析

doi:10.3877/cma.j.issn.1674-6902.2024.02.028

重症肺炎(severe pneumonia, SP)是细菌、病毒等致危重症状的肺部炎症，起病迅速、病情进展剧烈，SP死亡人数占重症监护室的40%^[1,2]。根据SP病情严重程度及时治疗对降低病死率有重要意义。全身性炎症因子C-反应蛋白(C-reactive protein, CRP)是反映SP病情严重程度的指标，与预后具有相关性^[3,4,5]。诱发SP的发病机制较多，CRP、降钙素原(procalcitonin, PCT)特异性较低，寻求新的有效指标有重要意义。人附睾蛋白4(human epididymal protein 4, HE4)是诊断卵巢癌的特异性标志物，在慢性肾脏疾病(chronic kidney disease, CKD)以及肺癌等肺部疾病中异常表达^[6]。HE4在慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)中呈高表达，与FEV₁%呈负相关，推动肺功能下降^[7]。HE4对SP病情及预测预后报道尚少。本文对我院收治的67例SP患者HE4表达水平及预后进行分析，报道如下。

关键词: 重症肺炎, 人附睾蛋白4, 预后

表1 影响SP患者预后单因素分析[(

±s)，n(%)]

临床资料	观察组(n＝29)	对照组(n＝38)	χ²/F	P值
吸烟史	18(62.07)	25(65.79)	0.090	0.753
合并疾病
心血管疾病	12(41.40)	15(39.47)	0.025	0.875
糖尿病	8(27.59)	10(26.32)	0.014	0.907
其他	9(31.03)	12(31.58)	0.002	0.962
HE4(pmol/L)	4 127.14±1 012.58	1 459.44±497.17	14.158	0.000
HBP (ng/ml)	101.25±18.69	59.34±17.84	9.332	0.000
CRP (mg/L)	161.34±64.22	168.54±58.34	0.479	0.634
PCT (ng/ml)	11.34±3.67	6.12±2.98	6.422	0.000
IL-6(pg/ml)	562.34±102.75	347.61±59.24	10.752	0.000
NEU(×10⁹/L)	13.64±4.97	9.34±3.61	4.101	0.000
LYM(×10⁹/L)	1.51±0.35	1.94±0.41	4.528	0.000
PLT(×10⁹/L)	236.64±74.96	194.64±54.36	2.658	0.010
NLR	9.03±2.94	4.91±1.68	7.229	0.000
WBC(×10⁹/L)	11.35±3.28	9.34±3.01	2.605	0.011
RDW	18.67±2.66	14.02±1.35	9.318	0.000

表1 影响SP患者预后单因素分析[(

±s)，n(%)]

临床资料	观察组(n＝29)	对照组(n＝38)	χ²/F	P值
吸烟史	18(62.07)	25(65.79)	0.090	0.753
合并疾病
心血管疾病	12(41.40)	15(39.47)	0.025	0.875
糖尿病	8(27.59)	10(26.32)	0.014	0.907
其他	9(31.03)	12(31.58)	0.002	0.962
HE4(pmol/L)	4 127.14±1 012.58	1 459.44±497.17	14.158	0.000
HBP (ng/ml)	101.25±18.69	59.34±17.84	9.332	0.000
CRP (mg/L)	161.34±64.22	168.54±58.34	0.479	0.634
PCT (ng/ml)	11.34±3.67	6.12±2.98	6.422	0.000
IL-6(pg/ml)	562.34±102.75	347.61±59.24	10.752	0.000
NEU(×10⁹/L)	13.64±4.97	9.34±3.61	4.101	0.000
LYM(×10⁹/L)	1.51±0.35	1.94±0.41	4.528	0.000
PLT(×10⁹/L)	236.64±74.96	194.64±54.36	2.658	0.010
NLR	9.03±2.94	4.91±1.68	7.229	0.000
WBC(×10⁹/L)	11.35±3.28	9.34±3.01	2.605	0.011
RDW	18.67±2.66	14.02±1.35	9.318	0.000

表2 SP患者预后的影响因素分析

变量	B	S.E，	Wals	Sig.	OR	EXP(B)的95%CI
变量	B	S.E，	Wals	Sig.	OR	下限	上限
HE4	1.068	0.468	5.220	0.022	2.910	1.164	7.276
HBP	0.242	0.108	4.992	0.025	1.274	1.030	1.576
PCT	0.001	0.000	5.256	0.022	1.001	1.000	1.001
IL-6	0.043	0.021	4.086	0.043	1.044	1.001	1.089
NEU	0.436	0.145	9.103	0.003	1.547	1.165	2.053
LYM	－2.441	0.955	6.541	0.011	0.087	0.013	0.565
PLT	0.017	0.010	2.862	0.091	1.017	0.997	1.037
NLR	0.961	0.241	15.863	0.000	2.615	1.629	4.197
LYM	0.662	0.701	0.894	0.344	1.939	0.491	7.656
RDW	0.314	0.394	0.638	0.425	1.369	0.633	2.961

表2 SP患者预后的影响因素分析

变量	B	S.E，	Wals	Sig.	OR	EXP(B)的95%CI
变量	B	S.E，	Wals	Sig.	OR	下限	上限
HE4	1.068	0.468	5.220	0.022	2.910	1.164	7.276
HBP	0.242	0.108	4.992	0.025	1.274	1.030	1.576
PCT	0.001	0.000	5.256	0.022	1.001	1.000	1.001
IL-6	0.043	0.021	4.086	0.043	1.044	1.001	1.089
NEU	0.436	0.145	9.103	0.003	1.547	1.165	2.053
LYM	－2.441	0.955	6.541	0.011	0.087	0.013	0.565
PLT	0.017	0.010	2.862	0.091	1.017	0.997	1.037
NLR	0.961	0.241	15.863	0.000	2.615	1.629	4.197
LYM	0.662	0.701	0.894	0.344	1.939	0.491	7.656
RDW	0.314	0.394	0.638	0.425	1.369	0.633	2.961

1	Cillóniz C, Torres A, Niederman MS. Management of pneumonia in critically ill patients[J]. BMJ, 2021, 375: e065871.
2	Baek MS, Park S, Choi JH, et al. Mortality and prognostic prediction in very elderly patients with severe pneumonia[J]. J Intensive Care Med, 2020, 35(12): 1405-1410.
3	Bateman RM, Sharpe MD, Jagger JE, et al. 36th international symposium on intensive care and emergency medicine: Brussels, Belgium. 15-18 March 2016[J]. Crit Care, 2016, 20(Suppl 2): 94.
4	Kesmez Can F, Özkurt Z, Öztürk N, et al. Effect of IL-6, IL-8/CXCL8, IP-10/CXCL 10 levels on the severity in COVID 19 infection[J]. Int J Clin Pract, 2021, 75(12): e14970.
5	Sayah W, Berkane I, Guermache I, et al. Interleukin-6, procalcitonin and neutrophil-to-lymphocyte ratio: Potential immune-inflammatory parameters to identify severe and fatal forms of COVID-19[J]. Cytokine, 2021, 141: 155428.
6	Zhang LS, Ling PY, Chen Y, et al. [Progress in the effect of human epididymis protein 4 on sperm maturation][J]. Zhonghua Yu Fang Yi Xue Za Zhi, 2022, 56(8): 1123-1126.
7	Huang X, Guo X, Yan G, et al. Dapagliflozin attenuates contrast-induced acute kidney injury by regulating the HIF-1α/HE4/NF-κB Pathway[J]. J Cardiovasc Pharmacol, 2022, 79(6): 904-913.
8	中国医师协会急诊医师分会. 中国急诊重症肺炎临床实践专家共识[J]. 中国急救医学，2016, 36(2): 11.
9	Ferreira-Coimbra J, Tejada S, Campogiani L, et al. Levels of evidence supporting European and American community-acquired pneumonia guidelines[J]. Eur J Clin Microbiol Infect Dis, 2020, 39(6): 1159-1167.
10	Bijlsma MW, Brouwer MC, Kasanmoentalib ES, et al. Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study[J]. Lancet Infect Dis, 2016, 16(3): 339-347.
11	Ren Q, Liu H, Wang Y, et al. The role of red blood cell distribution width in the severity and prognosis of community-acquired pneumonia[J]. Can Respir J, 2021, 2021: 8024024.
12	Song Y, Yang J, Sun H, et al. Serum levels of sirtuin 6 are associated with severe community acquired pneumonia in children: An observational study[J]. Cir Cir, 2022, 90(5): 632-637.
13	Kühnapfel A, Horn K, Klotz U, et al. Genetic regulation of cytokine response in patients with acute community-acquired pneumonia[J]. Genes (Basel), 2022, 13(1): 111.
14	陈晓珊. 血清PCT、RAGE、sTREM-1表达水平与重症肺炎患者病情严重程度及预后的关系[J]. 标记免疫分析与临床，2020, 27(1): 136-141.
15	Sun ML, Yang ZY, Wu QJ, et al. The role of human epididymis protein 4 in the diagnosis and prognosis of diseases: An umbrella review of systematic reviews and Meta-analyses of observational studies[J]. Front Med (Lausanne), 2022, 9: 842002.
16	Sütö R, Pócsi M, Szabó Z, et al. Elevated level of serum human epididymis protein 4 (HE4) predicts disease severity and mortality in COVID-19 pneumonia[J]. BMC Pulm Med, 2023, 23(1): 512.
17	Wang J, Zhao H, Xu F, et al. Human epididymis protein 4 (HE4) protects against cystic pulmonary fibrosis associated-inflammation through inhibition of NF-κB and MAPK singnaling[J]. Genes Genomics, 2019, 41(9): 1045-1053.
18	Luo J, Liang J, Wang S, et al. Serum human epididymis secretory protein 4 correlates with sepsis-associated acute respiratory distress syndrome and 28-day mortality in critically ill patients[J]. Ann Clin Biochem, 2022, 59(5): 338-346.
19	Raghu G, Richeldi L, Jagerschmidt A, et al. Idiopathic pulmonary fibrosis: Prospective, case-controlled study of natural history and circulating biomarkers[J]. Chest, 2018, 154(6): 1359-1370.
20	Saleem N, Kulkarni A, Snow T, et al. Effect of corticosteroids on mortality and clinical cure in community-acquired pneumonia: A systematic review, Meta-analysis, and Meta-regression of randomized control trials[J]. Chest, 2023, 163(3): 484-497.
21	Zhang C, He H, Chen X, et al. The prediction of lymphocyte count and neutrophil count on the efficacy of Xuebijing adjuvant treatment for severe community-acquired pneumonia: A post hoc analysis of a randomized controlled trial[J]. Phytomedicine, 2023, 110: 154614.
22	Ge YL, Zhang HF, Zhang Q, et al. Neutrophil-to-lymphocyte ratio in adult community-acquired pneumonia patients correlates with unfavorable clinical outcomes[J]. Clin Lab, 2019, 65(5): doi: 10.7754/Clin.Lab.2018.181042.
23	Kuikel S, Pathak N, Poudel S, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcome in patients with community-acquired pneumonia: A systematic review[J]. Health Sci Rep, 2022, 5(3): e630.
24	马晓迪，刘振宁. 中性粒细胞/淋巴细胞比值对重症急性胰腺炎病情严重程度及预后评估价值的研究进展[J]. 中国实用内科杂志，2023, 43(6): 518-521.
25	Meng Y, Zhang L, Huang M, et al. Blood heparin-binding protein and neutrophil-to-lymphocyte ratio as indicators of the severity and prognosis of community-acquired pneumonia[J]. Respir Med, 2023, 208: 107144.
26	Xiao X, Hong Y, Wang S, et al. Diagnostic value of plasma heparin-binding protein and the heparin-binding protein-to-albumin ratio in patients with community-acquired Pneumonia: a retrospective study[J]. BMC Infect Dis, 2023, 23(1): 777.
27	刘晓燕，张小佛，李　嘉，等. 肝素结合蛋白对儿童重症腺病毒肺炎的诊断价值[J]. 中国当代儿科杂志，2022, 24(9): 1014-1019.

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Analysis of HE4 expression levels and prognosis in severe pneumonia

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Analysis of HE4 expression levels and prognosis in severe pneumonia