【摘要】 目的:探究血清B7同系物3蛋白(B7-H3)、降钙素原(PCT)和可溶性细胞间黏附分子-1(SICAM-1)水平对呼吸机相关性肺炎(VAP)的预测价值。方法:选取2019年6月～2020年6月在界首市人民医院接受机械通气患者76例作为研究对象，根据患者是否发生VAP将其分为感染组(n=35)和未感染组(n=41),采用多因素Logistic回归模型分析VAP与B7-H3、PCT、sICAM-1的关系。结果:35例肺部感染患者检测出病原菌85株，革兰阳性菌∶革兰阴性菌株∶真菌株∶其他病原菌为28∶41∶14∶2。与未感染组相比，感染组患者的临床肺部感染评分(CPIS)、B7-H3、PCT以及sICAM-1水平较高(P<0.05)。Logistic多因素回归分析显示，B7-H3、PCT、sICAM-1是机械通气患者发生VAP的独立危险因素(P<0.05)。ROC曲线显示，血清B7-H3、PCT、sICAM-1对诊断VAP的曲线下面积(AUC)分别为0.743、0.854、0.845,对应灵敏度分别为82.43%、65.13%、73.26%,特异度分别为68.59%、94.11%、88.24%。三者联合诊断的AUC为0.933,灵敏度和特异度分别为83.72%和94.13%。结论:血清B7-H3、PCT、sICAM-1对VAP有一定的诊断价值，三者联合诊断效能更好。更多还原

【Abstract】 Objective:To investigate the predictive value of serum levels of B7 homolog 3 protein(B7-H3),procalcitonin(PCT),and soluble intercellular adhesion molecule-1(sICAM-1) in ventilator-associated pneumonia(VAP).Methods:Seventy-six patients undergoing mechanical ventilation in our hospital were included from June 2019 and June 2020,and divided into infected group(n=35) and uninfected group(n=41) by the presence of VAP.Multivariate logistic regression model was used to analyze the relationship between VAP and B7-H3,PCT and sICAM-1.Results:In 35 patients with pulmonary infections, 85 strains of pathogenic bacteria were detected, which ranked from Gram-positive, Gram-negative and fungus.Other pathogens were 28,41,14 and 2 strains, respectively.Compared with the uninfected group, patients in the infected group had higher levels of CPIS score, B7-H3,PCT and sICAM-1(P<0.05).Logistic multivariate regression analysis showed that B7-H3,PCT and sICAM-1 were independent risk factors for ventilator-associated pulmonary infections in mechanically ventilated patients(P<0.05).ROC results showed that the area under the curve(AUC) was respectively 0.743,0.854 and 0.845 for the serum B7-H3,PCT and sICAM-1 in the diagnosis of ventilator-associated pulmonary infection, and the sensitivity and specificity were 82.43%,65.13% and 73.26%;68.59%,94.11% and 88.24%,respectively.The AUC was 0.933 by combined diagnosis with the three serum indicators, and the sensitivity and specificity were 83.72% and 94.13%,respectively.Conclusion:Serum B7-H3,PCT,and sICAM-1 have certain diagnostic value for ventilator-associated pulmonary infections, and the combined diagnostic efficacy of the three indicators should be better.更多还原