目的 探讨血清及下呼吸道分泌物中分泌型白细胞蛋白酶抑制剂（SLPI）在重症肺炎中的评估价值。方法 选取合肥市第三人民医院重症医学科（ICU）90 例重症肺炎患者的临床资料，根据 28 d 生存情况分为存活组与死亡组，比较两组基线资料和入ICU及治疗24 h后的血清及下呼吸道分泌物SLPI、 血清肿瘤坏死因子⁃α（TNF⁃α）及白细胞介素⁃8（IL⁃8）水平；分析血清 SLPI 与下呼吸道分泌物 SLPI、TNF⁃α、 IL⁃8的相关性；进行二分类logistic 回归分析影响重症肺炎预后的影响因素；采用受试者工作特征（ROC）曲线分析血清及下呼吸道分泌物 SLPI 对重症肺炎预后的评估价值。结果 死亡组机械通气时间长于存活 组，余基线资料均差异无统计学意义（P > 0.05）。治疗 24 h 后，两组血清及下呼吸道分泌物 SLPI 均较治疗前升高，血清 TNF⁃α、IL⁃8 均较治疗前降低（P < 0.05）。存活组治疗后血清及下呼吸道分泌物 SLPI 均高于死亡组，血清 TNF⁃α、IL⁃8 均低于死亡组，（P < 0.05）。Spearman 相关性分析发现，血清 SLPI 与 TNF⁃α、IL⁃8 呈负相关（r = -0.583、-0.672，P < 0.001）；而与下呼吸道分泌物 SLPI 呈正相关（r = 0.527，P < 0.001）。二分 类 logistic 回归分析显示血清及下呼吸道分泌物 SLPI 是重症肺炎 28 d 死亡的保护因素（P < 0.05）。ROC 曲线分析显示治疗后血清及下呼吸道分泌物 SLPI 的曲线下面积（AUC）分别为 0.953、0.968，血清 SLPI < 87.59 ng/mL、下呼吸道分泌物 SLPI < 835.68 ng/mL 时患者预后差（P < 0.05）；二者联合预测效能高于单独 指标，AUC 为 0.991（P < 0.05）。结论 SLPI 是重症肺炎的保护因素，血清及下呼吸道分泌物 SLPI 或可作为重症肺炎治疗及预后评估的有效指标。 

Objective To investigate the value of secretory leukocyte protease inhibitor（SLPI）in serum and lower respiratory tract secretion in severe pneumonia. Methods 90 patients with severe pneumonia from the Intensive Care Unit（ICU）of the Third People′s Hospital of Hefei were selected for clinical data. They were respectively divided into a survival group and a death group based on their28⁃day survival status. Baseline data，serum and lower respiratory tract secretions（SLPI）and serum Tumor necrosis factor⁃α（TNF⁃α），Interleukin⁃8（IL⁃8）levels were compared between the two groups at admission to ICU and after 24 hours treatment.Analyzing the correlation between serum SLPI and lower respiratory secretions SLPI，TNF ⁃ αand IL ⁃8. Conduct binary logistic regression analysis on the influencing factors of prognosis for severe pneumonia. And used receiver operating characteristic （ROC）curve to analysis the evaluation value of patient serum and lower respiratory tract secretions（SLPI）for the prognosis of severe pneumonia. Results The mechanical ventilation time in the death group was longer than that in the survival group，and there was no significant difference in the remaining baseline data（P > 0.05）. After 24 hours of treatment，the serum and lower respiratory tract secretion SLPI of both groups increased compared to before，and serum TNF⁃α，IL⁃8 levels decreased（P < 0.05）. After treatment，the SLPI of serum and lower respira⁃ tory tract secretions in survival group were higher than those in the death group，and the serum TNF⁃α，IL⁃8 levels were lower than those in the death group（P < 0.05）. Spearman correlation analysis found that serum SLPI and TNF⁃ α，IL⁃8 showed a negative correlation（r = -0.583，-0.672，P < 0.001）；And there was a positive correlation with lower respiratory tract secretion SLPI（r = 0.527，P < 0.001）. The binary logistic regression analysis showed that serum and lower respiratory tract secretions（SLPI）were protective factors for 28 day mortality in severe pneumonia （P < 0.05）. ROC curve analysis showed that the area under the curve（AUC）of serum and lower respiratory secretion SLPI after treatment were 0.953 and 0.968. Patients with serum SLPI < 87.59 ng/mL and lower respiratory secretion SLPI < 835.68 ng/mL had poor prognosis（P < 0.05）；The combined prediction efficiency of the two indicators is higher than that of individual indicators，with an AUC of 0.991（P < 0.05）. Conclusion SLPI is a protective factor in severe pneumonia，serum and lower respiratory tract secretions SLPI may serve as effective indicators for the treat⁃ ment and predictive evaluation of severe pneumonia.