Abstract:

Objective　To analyze the relationships between serum Syndecan-1 (multiligand proteoglycan-1), Endocan-1 (endothelial cell-specific molecule-1), and GRP78 (glucose-regulated protein 78) levels and the disease severity and prognosis in elderly patients with severe pneumonia complicated by acute respiratory distress syndrome (ARDS). Methods　This retrospective study included 120 elderly patients with severe pneumonia complicated by ARDS (ARDS group) admitted to Weinan First Hospital from January 2023 to May 2024, consisting of 71 males and 49 females, with an age of (73.35±7.60) years old. Additionally, 84 elderly patients with severe pneumonia without ARDS (non-ARDS group) were included, consisting of 50 males and 34 females, with an age of (72.68±6.54) years old. According to the oxygenation index, the ARDS group was subdivided into a mild group [33 cases, oxygenation index > 200-300 mmHg (1 mmHg=0.133 kPa)], a moderate group (39 cases, oxygenation index of 100-200 mmHg), and a severe group (48 cases, oxygenation index ≤100 mmHg). According to the 28-day prognosis of the ARDS group, the patients were subdivided into a death group (36 cases) and a survival group (84 cases). A total of 80 healthy volunteers, including 45 males and 35 females, with an age of (71.29±7.20) years old, were selected as a control group. Serum levels of Syndecan-1, Endocan-1, and GRP78 were measured. Multivariate logistic regression analysis was conducted to identify factors affecting prognosis in elderly patients with severe pneumonia complicated by ARDS, and the receiver operating characteristic curve (ROC) was performed to assess the predictive values of serum biomarkers for mortality risk. t test and χ² test were used for statistical analysis. Results　Serum levels of Syndecan-1, Endocan-1, and GRP78 in the control group, non-ARDS group, and ARDS group increased sequentially (all P<0.05). In the mild, moderate, and severe groups, serum levels of Syndecan-1, Endocan-1, and GRP78 showed a gradual increasing trend (all P<0.05). The age, mechanical ventilation time, C-reactive protein, Syndecan-1, Endocan-1, and GRP78 levels in the death group were higher than those in the survival group [(76.72±8.20) years old vs. (71.90±7.42) years old, (4.78±1.12) d vs. (3.29±0.83) d, (113.97±42.98) mg/L vs. (85.74±33.03) mg/L, (97.45±10.48) g/L vs. (80.35±8.58) g/L, (4.80±0.88) ng/L vs. (3.40±0.52) ng/L, (30.37±5.57) µg/L vs. (23.84±4.40) µg/L], but the oxygenation index was lower than that in the survival group [(74.92±27.60) mmHg vs. (164.27±48.50) mmHg], with statistically significant differences (t=3.159, 8.081, 3.907, 9.346, 8.903, 6.862, and 12.743, all P<0.05). Age, mechanical ventilation time, Syndecan-1, Endocan-1, and GRP78 were independent risk factors for prognosis in elderly severe pneumonia patients complicated by ARDS (all P<0.05). The sensitivities of Syndecan-1, Endocan-1, and GRP78 for predicting poor prognosis in elderly severe pneumonia patients complicated by ARDS were 88.9%, 88.9%, and 72.2%, the specificities were 75.0%, 89.9%, and 85.7%, and the areas under the curves were 0.896, 0.921, and 0.823. When Syndecan-1, Endocan-1, and GRP78 were combined, the sensitivity and specificity were 94.4% and 92.9%, respectively, and the area under the curve was 0.987. Conclusion　Serum Syndecan-1, Endocan-1, and GRP78 are closely related to the severity and prognosis of elderly patients with severe pneumonia complicated by ARDS and serve as independent risk factors that significantly impact patient prognosis.

Key words:

Acute respiratory distress syndrome, Elderly severe pneumonia, Syndecan-1, Endocan-1, GRP78, Prognosis

摘要：

目的　分析老年重症肺炎并发急性呼吸窘迫综合征（ARDS）患者血清多配体聚糖-1（Syndecan-1）、内皮细胞特异分子-1（Endocan-1）、葡萄糖调节蛋白78（GRP78）与疾病严重程度及预后的关系。方法　本研究为回顾性研究。选取渭南市第一医院2023年1月至2024年5月收治的老年重症肺炎并发ARDS患者120例（ARDS组）与未并发ARDS患者84例（非ARDS组），ARDS组男71例、女49例，年龄（73.35±7.60）岁；非ARDS组男50例、女34例，年龄（72.68±6.54）岁。根据氧合指数将ARDS组分为轻度组［33例，氧合指数>200～300 mmHg（1 mmHg=0.133 kPa）］、中度组（39例，氧合指数100～200 mmHg）和重度组（48例，氧合指数≤100 mmHg）。并根据ARDS组患者28 d预后情况分为死亡组（36例）和存活组（84例）。同时，选取健康志愿者80例为对照组，其中男45例、女35例，年龄（71.29±7.20）岁。检测研究对象血清Syndecan-1、Endocan-1和GRP78水平。通过多因素logistic回归分析老年重症肺炎并发ARDS患者预后的影响因素，采用受试者操作特征曲线分析血清生物标志物对预后不良的预测价值。采用t检验、χ²检验进行统计分析。结果　对照组、非ARDS组、ARDS组血清Syndecan-1、Endocan-1、GRP78水平依次升高（均P<0.05）。轻度、中度、重度组血清Syndecan-1、Endocan-1、GRP78水平均呈逐渐升高趋势（均P<0.05）。死亡组的年龄、机械通气时间、氧合指数、C反应蛋白、Syndecan-1、Endocan-1、GRP78水平分别为（76.72±8.20）岁、（4.78±1.12）d、（74.92±27.60）mmHg、（113.97±42.98）mg/L、（97.45±10.48）g/L、（4.80±0.88）ng/L、（30.37±5.57）µg/L，存活组上述指标分别为（71.90±7.42）岁、（3.29±0.83）d、（164.27±48.50）mmHg、（85.74±33.03）mg/L、（80.35±8.58）g/L、（3.40±0.52）ng/L、（23.84±4.40）µg/L，差异均有统计学意义（t=3.159、8.081、12.743、3.907、9.346、8.903、6.862，均P<0.05）。年龄、机械通气时间、Syndecan-1、Endocan-1、GRP78均为老年重症肺炎并发ARDS患者预后不良的独立危险因素（均P<0.05）。Syndecan-1、Endocan-1和GRP78预测老年重症肺炎并发ARDS患者预后不良的灵敏度分别为88.9%、88.9%和72.2%，特异度分别为75.0%、89.9%和85.7%，曲线下面积分别为0.896、0.921和0.823；当Syndecan-1、Endocan-1和GRP78联合预测时，灵敏度和特异度分别为94.4%和92.9%，曲线下面积为0.987。结论　血清Syndecan-1、Endocan-1、GRP78均与老年重症肺炎并发ARDS患者的疾病严重程度及预后密切相关，且均为独立危险因素，对患者预后有重要影响。

关键词:

急性呼吸窘迫综合征, 老年重症肺炎, 多配体聚糖-1, 内皮细胞特异分子-1, 葡萄糖调节蛋白78, 预后