目的:研究血清血管生成素-2(serum angiopoietin-2, Ang-2)对社区获得性肺炎(CAP)患者病情的预测效果,以期为临床早期干预提供科学依据。方法:选取2020年1月至2021年12月收治的符合CAP诊断标准的患者145例,男性81例,女性64例;根据肺炎严重度指数(PSI)对145例患者进行评分并分组,低危72例,中危46例,高危27例。同时选取在郑州市第一人民医院进行健康体检的人群70例为对照组,查阅病历收集年龄、性别、体质量指数、吸烟史、饮酒史等基本资料,在患者入院当天(对照组为体检当日)收集静脉血,测定患者C反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PCT)、肿瘤坏死因子α(tumor necrosis factor-α, TNF-α)、 Ang-2、白细胞(white blood count, WBC)、 中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)、血小板与淋巴细胞比率(platelet to lymphocyte ratio, PLR)等实验室指标。结果:CAP患者和健康体检人群的年龄、男性占比、BMI及吸烟饮酒史比较差异无统计学意义(P＞0.05),CAP组患者的CRP、PCT、TNF-α、 Ang-2、WBC、 NLR、PLR等实验室指标较对照组均有显著提高(P＜0.05);随着CAP疾病危险程度的增加,患者的CRP、PCT、TNF-α、 Ang-2、WBC、 NLR、PLR等实验室指标均有显著上升(P＜0.05),患者Ang-2水平与CRP、PCT、TNF-α、WBC、NLR、PLR均呈正相关(r=0.458、0.368、0.481、0.512、0.419、0.268,P＜0.05);经ROC分析,当Ang-2的 最 佳 截 断 值 为5.051时,ROC曲线下面积为0.689,标准误差为0.023,95 % CI(0.125 - 2.004),预测 CAP 患者死亡的敏感度为75.32 %,特异度为70.38 %。结论:CAP患者的Ang-2相较于健康人群显著提高,且随着CAP病情的恶化而增加,Ang-2水平与CRP、PCT、TNF-α、WBC、NLR、PLR均呈正相关,提示临床上可以应用Ang-2对CAP患者的病情进行有效预测。
Objective: To study the predictive effect of serum angiopoietin-2 on the condition of patients with community-acquired pneumonia, aiming to provide a scientific basis for early clinical intervention. Methods: From January 2020 to December 2021, 145 patients (81 males and 64 females) who met the diagnostic criteria of CAP (Community Acquired Pneumonia) were selected. A total of 145 patients were scored and divided into three groups according to the Pneumonia Severity Index (PSI), 72 cases in the low-risk group, 46 cases in the moderate-risk group and 27 cases in the high-risk group. Meanwhile, 70 people who had physical examination in the First People's Hospital of Zhengzhou City were selected as the control group. The medical records were checked to collect basic data of patients such as age, sex, body mass index, smoking history, drinking history, etc. Venous blood was collected on the day of admission (the day of physical examination in the control group) to measure the level of CRP (C-reactive protein), PCT (procalcitonin), TNF-α (tumor necrosis factor-α), Ang-2 (serum angiopoietin-2), WBC (white blood count), NLR (neutrophil to lymphocyte ratio), and PLR (platelet to lymphocyte ratio). Results: There was no significant difference in age, male proportion, BMI, smoking and drinking history between the groups of CAP patients and the control group (P＞0.05). Compared with the control group, the levels of CRP, PCT, TNF-α, Ang-2, WBC, NLR in CAP patients were significantly improved, and the difference was statistically significant (P＜0.05). With the aggravation of the condition of CAP patients, levels of CRP, PCT, TNF-α, Ang-2, WBC, NLR and PLR were significantly increased (P＜0.05). Correlation analysis results showed that the level of Ang-2 in patients was positively correlated with CRP, PCT, TNF-α, WBC, NLR, and PLR level (r=0.458 , 0.368, 0.481, 0.512, 0.419, 0.268) (P＜0.05). ROC analysis results indicated that when the optimal cutoff value of Ang-2 was 5.051, the area under the ROC curve was 0.689, the standard error was 0.023, 95 % CI (0.125-2.004), with the sensitivity of 75.32 % in predicting death of CAP patients and the specificity of 70.38 %. Conclusion: The Ang-2 level of CAP patients was significantly higher than that of the healthy people, and could be increased with the aggravation of CAP. The Ang-2 level was positively correlated with CRP, PCT, TNF- α, WBC, NLR and PLR, suggesting that the level of Ang-2 could be used to predict the condition of patients with CAP effectively.
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