血清GDF-15和IL-12表达与老年患者ICU机械通气后肺部感染的相关性

Correlation of expression levels of serum GDF-15 and IL-12 with pulmonary infection after mechanical ventilation in elderly patients

摘要:

目的 观察生长分化因子15(GDF-15)和白细胞介素12(IL-12)在重症监护室(ICU)行机械通气后肺部感染老年患者血清中的表达水平,并探讨血清GDF-15、IL-12水平与ICU机械通气术后肺部感染的相关性。方法 选取2016年7月至2019年8月于哈尔滨医科大学附属第一医院ICU行机械通气术的老年患者169例作为观察组,其中发生感染患者71例作为肺部感染组,未发生感染者98例作为肺部未感染组；同期选取于本院体检结果无肺部疾病的老年人群102例作为对照组。采用酶联吸附(ELISA)法检测受试者血清GDF-15、IL-12表达水平并比较。采用SPSS 21.0软件进行数据分析。采用logistic分析老年患者ICU机械通气后肺部感染危险因素；绘制受试者工作特征(ROC)曲线分析血清GDF-15、IL-12表达水平对肺部感染的诊断价值。结果 肺部未感染组患者血清GDF-15、IL-12表达水平分别为(862.08±263.33)pg/ml和(70.88±14.61)pg/ml,肺部感染组分别为(1 431.42±310.50)pg/ml和(93.02±20.05)pg/ml,均高于对照组的(564.98±133.38)pg/ml和(46.90±20.14)pg/ml(q=12.443,13.097,33.211,23.052；P＜0.05)；肺部感染组患者血清GDF-15、IL-12表达水平高于肺部未感染组(q=21.643,10.975；P＜0.05)。logistic回归分析显示血清GDF-15、IL-12高水平是老年患者ICU机械通气后肺部感染的危险因素；血清GDF-15诊断老年患者ICU机械通气后肺部感染的ROC曲线下面积为0.895,灵敏度为76.1%,特异度为95.9%；血清IL-12诊断老年患者ICU机械通气后肺部感染的ROC曲线下面积为0.747,灵敏度为54.9%,特异度为85.7%；GDF-15与IL-12联合检测诊断肺部感染的ROC曲线下面积为0.940,灵敏度为81.7%,特异度为98.0%。结论 GDF-15、IL-12在ICU机械通气后肺部感染的老年患者血清中高表达,血清GDF-15、IL-12水平联合检测对老年患者ICU机械通气后肺部感染有较高诊断价值。

Abstract:

Objective To observe the expression levels of growth differentiation factor-15 (GDF-15) and interleukin-12 (IL-12) in the serum and their correlation with pulmonary infection after mechanical ventilation in the elderly patients in intensive care unit (ICU). Methods From July 2016 to August 2019,169 elderly patients who underwent mechanical ventilation in the ICU of the First Affiliated Hospital of Harbin Medical University were selected as the observation group, among whom 71 had pulmonary infection and 98 did not; 102 elderly people without lung disease were selected as the control group. The expression levels of GDF-15 and IL-12 in serum were measured and compared by enzyme-linked immunosorbent assay (ELISA). SPSS statistics 21.0 was used for data analysis. Logistic analyses were performed for the risk factors of pulmonary infection after mechanical ventilation, and receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of serum GDF-15 and IL-12 expression levels in pulmonary infection. Results The expression levels of serum GDF-15 and IL-12 were (862.08±263.33) pg/ml and (70.88±14.61) pg/ml in the group without pulmonary infection and(1 431.42±310.50) pg/ml,(93.02±20.05) pg/ml in the group with pulmonary, which were all higher than those in the control group [(564.98±133.38), (46.90±20.14) pg/ml; q=12.443,13.097,33.211,23.052; P<0.05]. The expression levels of GDF-15 and IL-12 in the group with pulmonary infection were higher than those in the group without (q=21.643, 10.975; P<0.05). Logistic regression analysis showed that the high levels of serum GDF-15 and IL-12 were the risk factors of pulmonary infection after mechanical ventilation. In the diagnosis of pulmonary infection after mechanical ventilation, the area under ROC curves (AUC) of serum GDF-15 was 0.895 with a sensitivity of 76.1% and a specificity of 95.9%, AUC of serum IL-12 was 0.747 with a sensitivity of 54.9% and a specificity of 85.7%, and AUC for them in combination was 0.940 with a sensitivity of 81.7% and a specificity of 98.0%. Conclusion GDF-15 and IL-12 are highly expressed in the serum of the elderly patients with pulmonary infection after mechanical ventilation in ICU. The combined detection of serum GDF-15 and IL-12 has a high diagnostic value for pulmonary infection after mechanical ventilation in the elderly patients.