血清OSM在合并心血管疾病老年社区获得性肺炎患者疾病严重程度及预后中的作用

The Role of Serum OSM in Disease Severity and Prognosis in Elderly Patients with Community-Acquired Pneumonia with Cardiovascular Disease

摘要: 目的：探讨血清抑瘤素M (oncostatin M, OSM)对合并心血管疾病老年社区获得性肺炎(community-acquired pneumonia, CAP)患者疾病严重程度及预后的评估价值。方法：本研究为前瞻性研究，纳入2020年11月至2021年11月于青岛市市立医院本部呼吸与危重症医学科、急诊科、重症监护室病房收治的144例合并心血管疾病老年CAP患者。根据患者住院期间生存状况将其分为生存组131例和死亡组13例。分析比较两组之间血清OSM水平及其与临床指标的相关性，采用Logistic回归分析影响合并心血管疾病老年CAP患者预后的危险因素，受试者工作特征(ROC)曲线分析OSM及其他临床指标对合并心血管疾病老年CAP患者死亡的价值。结果：死亡组血清OSM (109.16 ± 85.98)显著高于生存组[32.94 (14.54, 72.17)]，差异有统计学意义(P = 0.008)。Spearman相关性分析显示血清OSM与降钙素原、中性粒细胞计数、白介素-6、白介素-8、白细胞计数及C反应蛋白均呈正相关(P < 0.05)，而与淋巴细胞计数呈负相关(r = −0.392, P < 0.05)。采用二元Logistic回归分析显示，年龄和OSM是影响合并心血管疾病老年CAP患者死亡的独立危险因素(P < 0.05)。ROC曲线分析显示，OSM预测其住院期间死亡的曲线下面积(Area under the Curve, AUC)为0.723 (95%CI: 0.570~0.876, P = 0.008)，敏感度和特异性分别为69.2%和78.6%，优于其他单一实验室指标，如白介素-8、中性粒细胞淋巴细胞比值和降钙素原。结论：血清OSM是预测合并心血管疾病老年CAP患者住院期间死亡的独立危险因素，其对疾病的病情及预后显示出很好的预测作用。

Abstract: Purpose: To explore the value of serum oncostatin M (OSM) in evaluating the severity and prognosis of community-acquired pneumonia (CAP) in elderly patients with concomitant cardiovascular dis-ease. Methods: This was a prospective study that included 144 elderly CAP patients with concomi-tant cardiovascular disease admitted to the Respiratory and Critical Care Medicine Department, Emergency Department, and Intensive Care Unit at Qingdao Municipal Hospital from November 2020 to November 2021. The patients were divided into survival group (n = 131) and death group (n = 13) based on their survival status during hospitalization. The serum OSM levels and their cor-relation with clinical indicators between the two groups were analyzed and compared. Logistic re-gression analysis was used to identify the risk factors affecting the prognosis of elderly CAP patients with concomitant cardiovascular disease, while receiver operating characteristic (ROC) curve analy-sis was performed to evaluate the predictive value of OSM and other clinical indicators for mortality in these patients. Results: The serum OSM level in the death group (109.16 ± 85.98) was signifi-cantly higher than that in the survival group [32.94 (14.54, 72.17)], with a statistically significant difference (P = 0.008). Spearman correlation analysis showed that serum OSM was positively corre-lated with procalcitonin, neutrophil count, interleukin-6, interleukin-8, white blood cell count, and C-reactive protein (P < 0.05), while it was negatively correlated with lymphocyte count (r = −0.392, P < 0.05). Binary logistic regression analysis revealed that age and OSM were independent risk fac-tors for mortality in elderly CAP patients with concomitant cardiovascular disease (P < 0.05). ROC curve analysis demonstrated that the area under the curve (AUC) of OSM for predicting in-hospital mortality was 0.723 (95%CI: 0.570~0.876, P = 0.008), with a sensitivity of 69.2% and specificity of 78.6%, which outperformed other single laboratory indicators such as interleukin-8, neutro-phil-to-lymphocyte ratio, and procalcitonin. Conclusion: Serum OSM is an independent risk factor for predicting in-hospital mortality among elderly CAP patients with concomitant cardiovascular disease, and it exhibits good predictive value for assessing disease severity and prognosis.