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中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (02) : 275 -281. doi: 10.3877/cma.j.issn.1674-6902.2026.02.014

论著

血清钙卫蛋白水平动态变化与重症肺炎患者预后的相关性分析
张金1, 叶强2, 姚淳3, 许金凤4, 郑礼杰5,†()   
  1. 1212000　镇江，镇江市第一人民医院呼吸内科
    2212000　镇江，镇江市第一人民医院消化内科
    3212000　镇江，镇江市第一人民医院口腔科
    4212000　镇江，镇江市疾病预防控制中心检验科
    5212000　镇江，镇江市第一人民医院检验科
  • 收稿日期:2025-10-13 出版日期:2026-04-25
  • 通信作者: 郑礼杰
  • 基金资助:
    江苏省卫生健康委科研项目(Ym2023094)

Correlation analysis of dynamic changes of serum calprotectin level and prognosis in patients with severe pneumonia

Jin Zhang1, Qiang Ye2, Chun Yao3, Jinfeng Xu4, Lijie Zheng5,†()   

  1. 1Department of Respiratory Medicine, Zhenjiang First People′s Hospital, Zhenjiang 212000, China
    2Department of Gastroenterology, Zhenjiang First People′s Hospital, Zhenjiang 212000, China
    3Department of Dentistry, Zhenjiang First People′s Hospital, Zhenjiang 212000, China
    4Laboratory Department, Zhenjiang Center for Disease Control and Prevention, Zhenjiang 212000, China
    5Laboratory Department, Zhenjiang First People′s Hospital, Zhenjiang 212000, China
  • Received:2025-10-13 Published:2026-04-25
  • Corresponding author: Lijie Zheng
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引用本文：

张金, 叶强, 姚淳, 许金凤, 郑礼杰. 血清钙卫蛋白水平动态变化与重症肺炎患者预后的相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 275-281.

Jin Zhang, Qiang Ye, Chun Yao, Jinfeng Xu, Lijie Zheng. Correlation analysis of dynamic changes of serum calprotectin level and prognosis in patients with severe pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 275-281.

目的

分析血清钙卫蛋白(calprotectin, Cal)水平动态变化与重症肺炎(severe pneumonia)预后的相关性。

方法

选择2020年1月至2025年1月我院收治的164例重症肺炎患者为对象，根据患者预后分为观察组72例，对照组92例。检测入院第1天(T1)、第3天(T3)、第7天(T7)患者血清Cal，计算ΔQ1(T3-T1)、ΔQ2(T7-T1)和ΔQ1%[(T3-T1)/T1]和ΔQ2%[(T7-T1)/T1]。采用多因素Logistic回归分析影响预后因素，通过受试者特征工作曲线(receiver operating characteristic, ROC)、决策曲线分析(decision curve analysis, DCA)判断临床适用性。

结果

观察组中性粒细胞计数[(9.31±1.72)×109/L比(8.12±1.27)×109/L]、C反应蛋白(C-reactive protein, CRP)[(38.36±10.52)mg/L比(32.59±9.32)mg/L]、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluation Ⅱ，APACHEⅡ)评分[(17.53±2.14)分比(15.24±2.26)分]高于对照组(P<0.05)。观察组T3血清Cal[(10.43±1.25)μg/ml比(9.25±1.36)μg/ml]、T7血清Cal[(13.83±1.34)μg/ml比(10.12±1.78)μg/ml]高于对照组(P<0.05)；观察组ΔQ2[8.34(6.48，10.03)比4.75(3.74，6.45)]、ΔQ2%[1.39(0.90，2.37)比－0.98(－1.49，－0.59)]高于对照组(P<0.05)。多因素Logistic回归显示，中性粒细胞计数(OR＝1.069，95%CI：1.017~1.124)、CRP(OR＝1.506，95%CI：1.062~2.134)、APACHEⅡ评分(OR＝1.318，95%CI：1.085~1.600)、ΔQ2(OR＝4.358，95%CI：2.575~7.374)、ΔQ2%(OR＝0.137，95%CI：0.053~0.354)为预后影响因素(P<0.05)。受试者工作特征曲线(receiver operating characteristic, ROC)分析显示，中性粒细胞计数、CRP、APACHEⅡ评分、ΔQ2、ΔQ2%预测预后的曲线下面积(area under the curve, AUC)分别为0.677、0.670、0.733、0.661、0.750，联合预测AUC为0.940(95%CI：0.891~0.971)，敏感度90.28%，特异度85.87%。DCA显示，阈概率0.1~0.8时预测模型净获益差值0.05~0.15。

结论

重症肺炎患者入院早期动态检测血清Cal水平与预后相关，中性粒细胞计数、CRP、APACHEⅡ评分、ΔQ2、ΔQ2%升高为预后影响因子。

关键词: 重症肺炎, 血清钙卫蛋白, 动态变化, 决策曲线, 预后
Objective

To analyze the correlation between the dynamic changes in serum calprotectin (Cal) levels and the prognosis of severe pneumonia (SP).

Methods

Sixty-four patients with severe pneumonia admitted to our hospital from January 2023 to January 2025 were selected as subjects. They were grouped according to prognosis: 42 patients in the observation group, and 22 patients in the control group. Serum Cal levels were measured on admission day 1 (T1), day 3 (T3), and day 7 (T7). ΔQ1 (T3-T1), ΔQ2 (T7-T1), ΔQ1%[(T3-T1)/T1], and ΔQ2%[(T7-T1)/T1] were calculated. Multivariate logistic regression analysis was used to identify factors affecting prognosis. The clinical applicability was evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).

Results

The neutrophil count [(9.31±1.72) ×109/L vs. (8.12±1.27)×109/L], C-reactive protein (CRP) [(38.36±10.52) mg/L vs. (32.59±9.32) mg/L], and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [(17.53±2.14) points vs. (15.24±2.26) points] in the observation group were higher than those in the control group (P<0.05). The serum Cal in T3 of the observation group [(10.43±1.25) μg/ml vs. (9.25±1.36) μg/ml] and the serum Cal in T7 [(13.83±1.34) μg/ml vs. (10.12±1.78) μg/ml] were higher than those in the control group (P<0.05); the ΔQ2 in the observation group [(8.34 (6.48, 10.03) vs. 4.75 (3.74, 6.45)] and the ΔQ2% [(1.39 (0.90, 2.37) vs. -0.98 (-1.49, -0.59)] were higher than those in the control group (P<0.05). Multivariate Logistic regression showed that neutrophil count (OR=1.069, 95%CI: 1.017~1.124), CRP (OR=1.506, 95%CI: 1.062~2.134), APACHE Ⅱ score (OR=1.318, 95%CI: 1.085~1.600), ΔQ2 (OR=4.358, 95%CI: 2.575~7.374), and ΔQ2% (OR=0.137, 95%CI: 0.053~0.354) were prognostic factors (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for predicting prognosis by neutrophil count, CRP, APACHE Ⅱ score, ΔQ2, and ΔQ2% was 0.677, 0.670, 0.733, 0.661, and 0.750, respectively. The combined prediction AUC was 0.940 (95%CI: 0.891~0.971), with a sensitivity of 90.28% and a specificity of 85.87%. DCA showed that the net benefit difference of the prediction model at the threshold probability of 0.1 to 0.8 was 0.05 to 0.15.

Conclusion

The dynamic detection of serum Cal levels in the early stages of admission is associated with the prognosis of patients with severe pneumonia. Elevated neutrophil count, CRP, APACHE Ⅱ score, ΔQ2, and ΔQ2% are prognostic influencing factors.

Key words: Severe pneumonia, Serum calprotectin, Dynamic change, Decision curve, Prognosis
表1 两组重症肺炎患者临床资料结果
临床资料 观察组(n＝72) 对照组(n＝92) t/χ2值 P值
吸烟史[n(%)] 25(34.72) 27(29.35) 0.539 0.463
糖尿病[n(%)] 17(23.61) 13(14.13) 2.429 0.119
高血压[n(%)] 25(34.72) 26(28.26) 0.787 0.375
机械通气时间[d，(±s)] 6.34±1.15 5.97±1.28 1.945 0.054
住院时间[d，(±s)] 12.56±2.47 11.85±2.82 1.716 0.088
实验室指标(±s)        
白细胞计数(×109/L) 11.26±2.15 10.94±2.34 0.910 0.364
中性粒细胞计数(×109/L) 9.31±1.72 8.12±1.27 4.915 0.000
淋巴细胞计数(×109/L) 0.88±0.21 0.92±0.25 1.113 0.267
CRP(mg/L) 38.36±10.52 32.59±9.32 3.663 0.000
PCT(μg/L) 0.59±0.13 0.55±0.14 1.890 0.061
IL-6(pg/ml) 16.53±2.48 15.87±2.36 1.728 0.086
TNF-α(pg/ml) 19.32±2.53 18.54±2.74 1.889 0.061
PaO2(mmHg) 59.74±7.35 60.14±7.24 0.348 0.728
PaCO2(mmHg) 67.45±5.84 66.78±5.32 0.758 0.450
APACHE Ⅱ[分，(±s)] 17.53±2.14 15.24±2.26 6.635 0.000
CPIS评分[分，(±s)] 7.54±1.24 7.21±1.43 1.581 0.116
病原学类型[n(%)]     0.205 0.651
革兰氏阳性菌 44(61.11) 53(57.61)    
革兰氏阴性菌 28(38.89) 39(42.39)    
伴有COPD[n(%)] 18(25.00) 13(14.13) 3.113 0.078
合并心衰[n(%)] 9(12.50) 6(6.52) 1.737 0.188
表2 两组重症肺炎患者Cal动态水平比较
Cal水平 观察组(n＝72) 对照组(n＝92) t/Z值 P值
时相(±s)        
T1 5.63±1.72 5.19±1.68 1.642 0.103
T3 10.43±1.25 9.25±1.36 5.771 0.000
T7 13.83±1.34 10.12±1.78 7.018 0.000
动态变化[M(Q25，Q75)]        
ΔQ1 4.86(3.46，5.89) 4.16(2.74，5.64) 2.000 0.046
ΔQ2 8.34(6.48，10.03) 4.75(3.74，6.45) 7.404 0.000
ΔQ1% 0.84(0.48，1.40) 0.85(0.42，1.35) 0.593 0.553
ΔQ2% 1.39(0.90，2.37) 0.98(1.49，0.59) 3.978 0.000
表3 重症肺炎患者预后Logistic回归分析
自变量 β 标准误 Wald P值 OR 95%CI
下限 上限
中性粒细胞计数 0.067 0.026 6.797 0.009 1.069 1.017 1.124
CRP 0.409 0.178 5.283 0.022 1.506 1.062 2.134
APACHEⅡ评分 0.276 0.099 7.774 0.005 1.318 1.085 1.600
ΔQ2 1.472 0.268 30.076 0.000 4.358 2.575 7.374
ΔQ2% 1.987 0.484 16.868 0.000 0.137 0.053 0.354
常量 17.442 3.257 28.683        
图1 预测重症肺炎患者预后的DCA图注：High Risk Threshold为阈概率；Net Benefit为净收益；model 1为未包含ΔQ2、ΔQ2%；model 2为包含ΔQ2、ΔQ2%
表4 重症肺炎患者预后工作特征曲线分析
自变量 AUC Youden指数 95%CI P值 敏感度 特异度 最佳截断值
中性粒细胞计数 0.677 0.361 0.599~0.748 0.005 61.11 75.00  
APACHEⅡ评分 0.733 0.393 0.658~0.799 0.001 80.56 58.70  
CRP 0.670 0.345 0.592~0.741 0.000 63.89 70.65  
ΔQ2 0.661 0.312 0.583~0.733 0.001 73.61 57.61 >5.07
ΔQ2% 0.750 0.454 0.676~0.814 0.000 88.89 56.52 >0.33
联合 0.940 0.762 0.891~0.971 0.000 90.28 85.87  
1
Bassetti M, Giacobbe DR, Magnasco L, et al. Antibiotic strategies for severe community-acquired pneumonia[J]. Semin Respir Crit Care Med, 2024, 45(2): 187-199.
2
Tai X, Zhou X. Analysis of risk factors for negative emotions in patients with severe pneumonia and their impact on prognosis[J]. J Thorac Dis, 2023, 15(5): 2680-2693.
3
赖乾德，吕小容，吕相琴，等. 肝素结合蛋白及降钙素原对细菌性肺炎病情严重程度的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(4): 570-574.
4
Amaya-Garrido A, Brunet M, Buffin-Meyer B, et al. Calprotectin is a contributor to and potential therapeutic target for vascular calcification in chronic kidney disease[J]. Sci Transl Med, 2023, 15(712): eabn5939.
5
Marino M, Del Bo′ C, Martini D, et al. A (poly)phenol-rich diet reduces serum and faecal calprotectin in older adults with increased intestinal permeability: the MaPLE randomised controlled trial[J]. BMC Geriatr, 2024, 24(1): 707.
6
Mellor LF, Gago-Lopez N, Bakiri L, et al. Keratinocyte-derived S100A9 modulates neutrophil infiltration and affects psoriasis-like skin and joint disease[J]. Ann Rheum Dis, 2022, 81(10): 1400-1408.
7
Shokri-Afra H, Moradi M, Musavi H, et al. Serum calprotectin can indicate current and future severity of COVID-19[J]. J Clin Lab Anal, 2023, 37(1): e24809.
8
Yanhong R, Shuai Z, Dan C, et al. Predictive value of lactate dehydrogenase for Mycoplasma pneumoniae necrotizing pneumonia in children based on decision curve analysis and dose-response analysis[J]. Sci Rep, 2024, 14(1): 9803.
9
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): 97-107.
10
陈洁茹，陈伟燕，熊旭明. APACHEⅡ评分系统在综合ICU中的应用[J]. 广东医学，2013, 34(1): 86-89.
11
吴小妹，许丽妹，刘双双，等. 呼吸机相关性肺炎治疗结局预测分析[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(4): 647-649.
12
Peng B, Li J, Chen M, et al. Clinical value of glucocorticoids for severe community-acquired pneumonia: A systematic review and meta-analysis based on randomized controlled trials[J]. Medicine (Baltimore), 2023, 102(46): e36047.
13
Doda P, Kerai S, Chauhan K, et al. Comparison of acute physiology and chronic health evaluation (APACHE) Ⅱ and american college of surgeons national surgical quality improvement program (ACS-NSQIP) scoring system in predicting postoperative mortality in patients undergoing emergency laparotomy: A retrospective study[J]. Indian J Anaesth, 2024, 68(3): 231-237.
14
Duijkers R, Prins HJ, Kross M, et al. Biomarker guided antibiotic stewardship in community acquired pneumonia: A randomized controlled trial[J]. PLoS One, 2024, 19(8): e0307193.
15
Smit JM, Van Der Zee PA, Stoof S, et al. Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials[J]. Lancet Respir Med, 2025, 13(3): 221-233.
16
Zhang R, Sun C, Han Y, et al. Neutrophil autophagy and NETosis in COVID-19: perspectives[J]. Autophagy, 2023, 19(3): 758-767.
17
Pan J, Bu W, Guo T, et al. Development and validation of an in-hospital mortality risk prediction model for patients with severe community-acquired pneumonia in the intensive care unit[J]. BMC Pulm Med, 2023, 23(1): 303.
18
Hsu CW, Suk CW, Hsu YP, et al. Sphingosine-1-phosphate and CRP as potential combination biomarkers in discrimination of COPD with community-acquired pneumonia and acute exacerbation of COPD[J]. Respir Res, 2022, 23(1): 63.
19
Tsai D, Secombe P, Chiong F, et al. Prediction accuracy of commonly used pneumonia severity scores in Aboriginal patients with severe community-acquired pneumonia: a retrospective study[J]. Intern Med J, 2023, 53(1): 51-60.
20
Sumi T, Sekikawa M, Koshino Y, et al. Risk factors for severe immune-related pneumonitis after nivolumab plus ipilimumab therapy for non-small cell lung cancer[J]. Thorac Cancer, 2024, 15(20): 1572-1581.
21
Moodabagil M, Easterling R, Peng J, et al. Investigating risk factors and treatment options for severe, partially steroid responsive, and steroid-refractory checkpoint inhibitor pneumonitis[J]. Oncologist, 2024, 29(11): e1575-e1585.
22
García de Guadiana-Romualdo L, Rodríguez Rojas C, Morell-García D, et al. Circulating levels of calprotectin, a signature of neutrophil activation in prediction of severe respiratory failure in COVID-19 patients: a multicenter, prospective study (CalCov study)[J]. Inflamm Res, 2022, 71(1): 57-67.
23
Toma L, Dodot M, Zgura A, et al. Calprotectin in viral systemic infections-COVID-19 versus hepatitis C virus[J]. Clin Exp Med, 2022, 22(2): 311-317.
24
Hetland G, Fagerhol MK, Dimova-Svetoslavova VP, et al. Inflammatory markers calprotectin, NETs, syndecan-1 and neopterin in COVID-19 convalescent blood donors[J]. Scand J Clin Lab Invest, 2022, 82(6): 481-485.
25
Infantino M, Manfredi M, Alessio MG, et al. Clinical utility of circulating calprotectin to assist prediction and monitoring of COVID-19 severity: An Italian study[J]. J Med Virol, 2022, 94(12): 5758-5765.
26
Abu Hussein N, Machahua C, Ruchti SC, et al. Circulating calprotectin levels four months after severe and non-severe COVID-19[J]. BMC Infect Dis, 2023, 23(1): 650.
27
Kassianidis G, Siampanos A, Poulakou G, et al. Calprotectin and imbalances between acute-phase mediators are associated with critical illness in COVID-19[J]. Int J Mol Sci, 2022, 23(9): 4894.
28
Mellett L, Amarasinghe G, Farnsworth CW, et al. Elevated level of circulating but not urine S100A8/A9 identifies poor COVID-19 outcomes[J]. ACS Infect Dis, 2023, 9(10): 1815-1820.
29
Kaya T, Yaylacı S, Nalbant A, et al. Serum calprotectin as a novel biomarker for severity of COVID-19 disease[J]. Ir J Med Sci, 2022, 191(1): 59-64.
30
Hansen AH, Mortensen JH, Rønnow SR, et al. A serological neoepitope biomarker of neutrophil elastase-degraded calprotectin, associated with neutrophil activity, identifies idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease more effectively than total calprotectin[J]. J Clin Med, 2023, 12(24): 7589.
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