目的

分析血清可溶性髓系细胞触发受体-1（soluble triggering receptor expressed on myeloid cell-1，sTREM-1）、血管细胞黏附分子-1（vascular cell adhesion molecule-1，VCAM-1）水平对重症肺炎并发呼吸衰竭患者预后的意义。

方法

回顾性分析我院于2021 年1 月至2023 年12 月诊治的58 例重症肺炎并发呼吸衰竭患者，依据入院后结局，预后差20 例为观察组，存活者38 例为对照组。 比较两组性别、体质指数、年龄、心率、合并疾病、住院时间、重症监护室（intensive care unit，ICU）住院时间、机械通气时间、吸烟史、饮酒史、急性生理慢性健康评分（acute physiological and chronic health score，APACHE Ⅱ）、序贯器官功能衰竭评估（sequential organ failure assessment，SOFA）评分；血小板计数、淋巴细胞计数、白细胞计数、血清sTREM-1、VCAM-1 水平及影像学表现之间的差异，经ROC 分析APACHE Ⅱ评分、白细胞计数、血清VCAM-1、sTREM-1 水平用于重症肺炎并发呼吸衰竭患者预后，多因素Logistic 回归分析重症肺炎并发呼吸衰竭患者预后不良的风险因素。

结果

两组性别、BMI、年龄、心率、住院时间、ICU 住院时间、机械通气时间、并发疾病、吸烟史、饮酒史、SOFA 评分及血小板计数、淋巴细胞计数、影像学表现无统计学意义（P＞0.05）；对照组白细胞计数（13.46±4.16）×10⁹/L^-1、APACHE Ⅱ评分（17.46±3.26）分、血清sTREM-1（75.39±13.27）ng/L、VCAM-1（89.21±10.49）ng/L 水平低于观察组（19.97±4.26）×10⁹/L^-1、（21.32±3.54）分、（92.65±15.65）ng/L、（104.32±12.35）ng/L（P＜0.05）。 经ROC 分析显示，白细胞计数、APACHE Ⅱ评分、血清sTREM-1、VCAM-1 水平可用于重症肺炎并发呼吸衰竭患者预后，曲线下面积分别为0.857、0.782、0.822、0.832（P＜0.05）。 经多因素Logistic 回归分析显示，白细胞计数≥17.215×10⁹/L^-1、APACHE Ⅱ评分≥46.195 分、sTREM-1≥87.280 ng/L、VCAM-1≥93.780 ng/L 是重症肺炎并发呼吸衰竭患者预后不良的风险因素（P＜0.05）。

结论

重症肺炎并发呼吸衰竭患者预后受到诸多因素影响，其中白细胞计数≥17.215×10⁹/L^-1、APACHE Ⅱ评分≥46.195 分、sTREM-1≥87.280 ng/L、VCAM-1≥93.780 ng/L 时可预测预后不良具有意义。

Objective

To analyze the prognostic value of serum soluble myeloid cell trigger receptor-1（sTREM-1） and vascular cell adhesion molecule-1 （VCAM-1） levels in patients with severe pneumonia complicated with Respiratory failure.

Methods

Retrospective analysis of data from 58 patients with severe pneumonia complicated with respiratory failure treated at the First People′s Hospital of Huai′an City from January 2021 to December 2023，based on their prognosis after admission，they were divided into 38 cases survival is control group and 20 cases death is observation group.Compare two sets of general data ［gender，BMI，age，heart rate，comorbidities，length of hospital stay，Intensive care unit （ICU） stay，mechanical ventilation time，smoking history，drinking history，acute physiological chronic health score （APACHE Ⅱ），sequential organ failure assessment （SOFA） score］ and differences in laboratory indicators ［platelet count，lymphocyte count，white blood cell count，serum sTREM-1，VCAM-1 levels］，and analyze the APACHE Ⅱscore through ROC The value of white blood cell count，serum VCAM-1，and sTREM-1 levels in predicting the prognosis of patients with severe pneumonia combined with respiratory failure.Multivariate logistic regression analysis identifies risk factors for poor prognosis in patients with severe pneumonia combined with respiratory failure.

Results

Comparison of gender，BMI，age，heart rate，hospital stay，ICU stay，mechanical ventilation time，comorbidities，smoking history，alcohol consumption history，SOFA score，platelet count，lymphocyte count between the two groups （P＞0.05）.The control group had lower white blood cell count（13.46±4.16）×10⁹/L^-1，APACHE Ⅱscore（17.46±3.26），serum sTREM-1（75.39±13.27）ng/L，VCAM-1 levels（89.21±10.49）ng/L than the observation group（19.97±4.26）×10⁹/L^-1，（21.32±3.54），（92.65±15.65）ng/L，（104.32±12.35）ng/L（P＜0.05）.ROC analysis confirmed that white blood cell count，APACHE Ⅱscore，serum sTREM-1 and VCAM-1 levels can be used to predict the prognosis of patients with severe pneumonia complicated with Respiratory failure.The area under the curve was 0.857，0.782，0.822 and 0.832，respectively，all P ＜0.05.Confirmed by multivariate logistic regression analysis，white blood cell count≥17.215×10⁹/L^-1，APACHE Ⅱscore ≥46.195，sTREM-1 ≥87.280 ng/L，VCAM-1≥93.780 ng/L were risk factors for poor prognosis in patients with severe pneumonia complicated with Respiratory failure，all of which were P ＜0.05.

Conclusion

The prognosis of patients with severe pneumonia complicated with Respiratory failure is affected by many factors，among which white blood cell count ≥17.215×10⁹/L^-1，APACHE Ⅱscore≥46.195，sTREM-1≥87.280 ng/L，VCAM-1≥93.780 ng/L can predict the occurrence of poor prognosis，and clinical physicians should closely monitor during the treatment of this disease.