老年肺炎外周血活化蛋白C、血栓素B2、可溶性B7-H3水平与病情程度和预后的相关性

doi:10.3969/j.issn.1006-5725.2025.07.019

摘要/Abstract

摘要：

目的探讨老年肺炎外周血活化蛋白C（APC）、血栓素B2（TXB2）、可溶性B7-H3（sB7-H3）水平与病情程度和预后的相关性。方法选取老年肺炎患者100例作为研究组，另选取同期健康志愿者100例作为对照组。比较两组外周血APC、TXB2、sB7-H3水平。研究组根据英国胸科协会改良肺炎评分（CURB-65评分）判定病情程度，分为低危患者、中危患者和高危患者。比较不同病情程度患者外周血APC、TXB2、sB7-H3水平。Pearson相关性分析外周血APC、TXB2、sB7-H3水平与病情程度的相关性。对研究组随访30 d，根据预后分为预后良好亚组与预后不良亚组，比较研究组不同预后患者临床资料、外周血APC、TXB2、sB7-H3水平。偏相关性分析外周血APC、TXB2、sB7-H3水平与预后的相关性。受试者工作特征（ROC）曲线分析预测价值。结果研究组外周血APC水平低于对照组，TXB2、sB7-H3水平高于对照组（P < 0.05）；研究组根据CURB-65评分判定病情程度，其中轻度患者33例，中度患者39例，重度患者28例。重度患者外周血APC水平低于中度患者、轻度患者，中度患者低于轻度患者，重度患者TXB2、sB7-H3水平高于中度患者、轻度患者，中度患者高于轻度患者（P < 0.05）；Pearson相关性分析，外周血APC与CURB-65评分呈负相关，TXB2、sB7-H3与CURB-65评分呈正相关（P < 0.05）；研究组随访30 d，预后不良亚组外周血APC水平低于预后良好亚组，TXB2、sB7-H3水平高于预后良好亚组（P < 0.05）；偏相关性分析，外周血APC、TXB2、sB7-H3与预后显著相关（P < 0.05）；ROC曲线分析，外周血APC、TXB2、sB7-H3预测老年肺炎患者预后的AUC为0.752、0.738、0.761，敏感度为66.67%、76.19%、66.67%，特异度为78.48%、67.09%、78.48%；三者联合预测老年肺炎患者预后的AUC为0.918，敏感度为85.71%，特异度为87.34%，较各指标单独预测价值显著提升（Z = 2.207、2.666、2.109，P = 0.027、0.008、0.035）。结论老年肺炎外周血APC、TXB2、sB7-H3与病情程度和预后显著相关，联合检测时能较为可靠地预测预后情况。

关键词: 肺炎, 活化蛋白C, 血栓素B2, 可溶性B7-H3, 病情程度, 预后

Abstract:

Objective To investigate the correlation between the levels of activated protein C （APC）， thromboxane B2 （TXB2）， and soluble B7?H3 （sB7?H3） in the peripheral blood of elderly patients with pneumonia and the severity as well as prognosis of the disease. Methods One hundred elderly pneumonia patients admitted to our hospital from March 2022 to June 2024 were enrolled as the study group， and 100 healthy volunteers during the same period were selected as the control group. The levels of APC， TXB2， and sB7?H3 in peripheral blood were compared between the two groups. Study group patients were further categorized into low?risk， medium?risk， and high?risk subgroups based on the CURB?65 score （Confusion， Uremia， Respiratory rate， Blood pressure， Age ≥ 65 years）. The levels of APC， TXB2， and sB7?H3 in peripheral blood were compared among patients with varying disease severities. Pearson correlation analysis was performed to evaluate the correlation between the levels of APC， TXB2， and sB7?H3 in peripheral blood and disease severity. The study group was followed up for 30 days and subsequently divided into good prognosis and poor prognosis subgroups according to their clinical outcomes. Clinical data and peripheral blood levels of APC， TXB2， and sB7?H3 were compared between patients with different prognoses. Partial correlation analysis was conducted to assess the relationship between peripheral blood levels of APC， TXB2， and sB7?H3 and prognosis. Finally， the predictive value of these biomarkers was evaluated using the Receiver Operating Characteristic （ROC） curve. Results The level of APC in the peripheral blood of the study group was significantly lower than that of the control group， whereas the levels of TXB2 and sB7?H3 were significantly higher （P <0.05）. The severity of the disease in the study group was assessed using the CURB?65 score， which categorized patients into 33 mild cases， 39 moderate cases， and 28 severe cases. Severe patients exhibited a lower level of APC in peripheral blood compared to moderate and mild patients. Additionally， the levels of TXB2 and sB7?H3 in moderate patients were higher than those in mild patients， while severe patients demonstrated even higher levels of TXB2 and sB7?H3 compared to both moderate and mild patients （P < 0.05）. Pearson correlation analysis revealed that peripheral blood APC was negatively correlated with the CURB?65 score， whereas TXB2 and sB7?H3 were positively correlated with the CURB?65 score （P < 0.05）. During a 30?day follow?up period， the research team identified 79 patients with good prognoses and 21 patients with poor prognoses. Significant differences were observed in diabetes prevalence， disease severity， and APACHEⅡ scores between the poor prognosis subgroup and the good prognosis subgroup （P < 0.05）. The levels of APC in peripheral blood were significantly lower in the poor prognosis subgroup compared to the good prognosis subgroup， whereas the levels of TXB2 and sB7?H3 were significantly higher （P < 0.05）. Partial correlation analysis revealed that peripheral blood APC， TXB2， and sB7?H3 were significantly associated with prognosis （P < 0.05）. The AUC values for predicting the prognosis of elderly pneumonia patients using peripheral blood APC， TXB2， and sB7?H3 were 0.752， 0.738， and 0.761， respectively， with sensitivities of 66.67%， 76.19%， and 66.67%， and specificities of 78.48%， 67.09%， and 78.48%. When combining these three indicators for prognostic prediction， the AUC increased to 0.918， with a sensitivity of 85.71% and a specificity of 87.34%， demonstrating a significant improvement in predictive accuracy compared to each indicator used alone （Z = 2.207， 2.666， 2.109， P = 0.027， 0.008， 0.035）. Conclusion The levels of APC， TXB2， and sB7?H3 in the peripheral blood of elderly patients with pneumonia are significantly associated with the severity and prognosis of the disease. Combined detection of these biomarkers can serve as a reliable predictor of clinical outcomes.

Key words: pneumonia, activated protein C, thromboxane B2, soluble B7?H3, the severity of the disease, prognosis

中图分类号:

R563.1

郑富霞,苗丽君,黄凤祥,黄仕夫,高增艳,张瑞霞,孟泳. 老年肺炎外周血活化蛋白C、血栓素B2、可溶性B7-H3水平与病情程度和预后的相关性[J]. 实用医学杂志, 2025, 41(7): 1056-1061.

Fuxia ZHENG,Lijun MIAO,Fengxiang HUANG,Shifu HUANG,Zengyan GAO,Ruixia ZHANG,Yong MENG. The correlation between the levels of APC， TXB2， and sB7⁃H3 in peripheral blood of elderly patients with pneumonia and the severity and prognosis of the disease[J]. The Journal of Practical Medicine, 2025, 41(7): 1056-1061.

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组别	例数	APC/（ng/mL）	TXB2/（ng/L）	sB7-H3/（pg/mL）
研究组	100	286.72 ± 72.13	366.49 ± 114.32	3 815.77 ± 836.19
对照组	100	445.58 ± 80.37	202.65 ± 52.12	2 560.28 ± 352.74
t值		14.711	13.040	13.834
P值		< 0.001	< 0.001	< 0.001

组别	例数	APC（ng/mL）	TXB2（ng/L）	sB7-H3（pg/mL）
轻度患者	33	345.23 ± 67.26	307.43 ± 58.19	3 276.09 ± 571.23
中度患者	39	281.61 ± 62.59^?	365.92 ± 63.37^?	3 807.44 ± 602.18^?
重度患者	28	224.88 ± 57.80^?#	436.89 ± 80.05^?#	4 463.42 ± 632.57^?#
F值		27.934	28.375	29.576
P值		< 0.001	< 0.001	< 0.001

资料	预后不良组（n = 21）	预后良好组（n = 79）	t/χ ² 值	P值
性别/［例（%）］			0.093	0.761
男	13（61.90）	46（58.23）
女	8（38.10）	33（41.77）
年龄/岁	67.82 ± 2.54	67.59 ± 2.30	0.399	0.691
BMI/（kg/m²）	22.06 ± 1.69	22.18 ± 1.74	0.283	0.778
吸烟史/［例（%）］	9（42.86）	30（37.97）	0.166	0.684
高血压/［例（%）］	7（33.33）	23（29.11）	0.141	0.708
糖尿病/［例（%）］	7（33.33）	10（12.66）	5.026	0.025
肺炎类型/［例（%）］			0.002	0.964
细菌性肺炎	17（80.95）	66（83.54）
病毒性肺炎	4（19.05）	13（16.46）
病情程度/［例（%）］			5.267	< 0.001
低危	1（4.76）	32（40.51）
中危	2（9.52）	37（46.84）
高危	18（85.71）	10（12.66）
APACHEⅡ评分/分	20.65 ± 2.13	18.40 ± 1.75	4.997	< 0.001
外周血指标
APC/（ng/mL）	233.63 ± 58.44	300.83 ± 68.39	4.117	< 0.001
TXB2/（ng/L）	435.15 ± 84.20	348.24 ± 106.37	3.463	0.001
sB7-H3/（pg/mL）	4 457.92 ± 769.36	3 645.07 ± 812.75	4.118	< 0.001

变量	偏相关系数	95%CI	P值
APC	-0.808	0.711 ~ 0.965	< 0.001
TXB2	0.857	0.748 ~ 0.981	< 0.001
sB7-H3	0.844	0.727 ~ 0.980	< 0.001

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