血清PSPH、CXCL2与脓毒症并发急性呼吸窘迫综合征患者预后和肺部微生态的关系

孙逊; 李玮; 王天轶; 谢云

血清PSPH、CXCL2与脓毒症并发急性呼吸窘迫综合征患者预后和肺部微生态的关系

投稿时间：2025-08-13 修订日期：2025-08-21 点此下载全文

引用本文：孙逊,李玮,王天轶,谢云.血清PSPH、CXCL2与脓毒症并发急性呼吸窘迫综合征患者预后和肺部微生态的关系[J].医学研究杂志,2026,55(1):110-115

DOI： 10.11969/j.issn.1673-548X.2026.01.019

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作者	单位
孙逊	解放军联勤保障部队第980医院石家庄,050051 通信作者:孙逊,副主任医师,电子信箱:Sunxun98071doc@outlook.com〖JZ
李玮	解放军联勤保障部队第980医院石家庄,050051 通信作者:孙逊,副主任医师,电子信箱:Sunxun98071doc@outlook.com〖JZ
王天轶	解放军联勤保障部队第980医院石家庄,050051 通信作者:孙逊,副主任医师,电子信箱:Sunxun98071doc@outlook.com〖JZ
谢云	解放军联勤保障部队第980医院石家庄,050051 通信作者:孙逊,副主任医师,电子信箱:Sunxun98071doc@outlook.com〖JZ

基金项目:2025年度河北省医学科学研究课题计划(20251033)

中文摘要:目的在探讨血清磷酸丝氨酸磷酸酶(phosphoserine phosphatase, PSPH)和C-X-C基序趋化因子配体2(C-X-C motif chemokine ligand 2,CXCL2)水平与脓毒症并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者预后及肺部微生态的关系。方法回顾性分析2022年1月~2025年1月解放军联勤保障部队第980医院收治的280例脓毒症并发ARDS患者的临床资料,根据28天内预后情况将患者分为生存组(n=180)和死亡组(n=100)。检测两组患者的血清PSPH和CXCL2水平,并进行肺部微生态分析。采用Spearman或Pearson相关性分析评估血清PSPH、CXCL2与肺部微生态的相关性；多因素Logistic回归分析确定影响预后的风险因素；受试者工作特征(receiver operating characteristic,ROC)曲线分析评估血清PSPH、CXCL2水平对预后的预测价值。结果两组患者的机械通气时间、动脉氧合指数、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分比较,差异有统计学意义(P<0.05)。与生存组比较,死亡组患者血清PSPH和CXCL2水平显著升高(P<0.05)。相关性分析显示,血清PSPH和CXCL2水平呈正相关(r=0.420,P<0.05),且二者均与肺部厚壁菌门丰度呈负相关(r=-0.331,P<0.05；r=-0.343,P<0.05),与肺部变形菌门丰度呈正相关(r=0.292,P<0.05；r=0.388,P<0.001)。多因素Logistic回归分析显示,氧合指数是脓毒症并发ARDS患者预后的保护因素(P<0.05),而机械通气时间、SOFA评分、PSPH和CXCL2水平为危险因素(P<0.05)。ROC曲线分析显示,血清PSPH、CXCL2单独及联合预测预后的曲线下面积分别为0.823(0.777~0.883)、0.822(0.772~0.871)和0.903(0.869~0.938),联合诊断的敏感度和特异性均高于单独诊断。结论血清PSPH和CXCL2水平与脓毒症并发ARDS患者的预后及肺部微生态密切相关,可作为预测预后的辅助指标。

中文关键词:脓毒症急性呼吸窘迫综合征磷酸丝氨酸磷酸酶 C-X-C基序趋化因子配体2 预后

Relationship between Serum PSPH, CXCL2 and Prognosis and Pulmonary Microecology in Patients with Sepsis Complicated by Acute Respiratory Distress Syndrome.

Abstract:Objective To investigate the relationship between serum phosphoserine phosphatase (PSPH) and C-X-C motif chemokine ligand 2 (CXCL2) levels and the prognosis and pulmonary microbiota in patients with sepsis-associated acute respiratory distress syndrome (ARDS). Methods A retrospective analysis was conducted on the clinical data of 280 patients with sepsis-associated ARDS admitted to 980th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army from January 2022 to January 2025. Patients were divided into survival group (180 cases) and death group (100 cases) based on their prognosis within 28days. The levels of serum PSPH and CXCL2 were measured in both groups, and pulmonary microbiota analysis was performed. Spearman and Pearson correlation analysis were used to assess the relationship between serum PSPH, CXCL2, and pulmonary microbiota. Multivariate Logistic regression analysis was conducted to identify risk factors for prognosis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of serum PSPH and CXCL2 levels for prognosis. Results There were statistically significant differences between the two groups in terms of mechanical ventilation duration, arterial oxygenation index, and sequential organ failure assessment (SOFA) score (P<0.05). Compared with the survival group, patients in the death group had significantly higher levels of serum PSPH and CXCL2 (P<0.05). Correlation analysis showed that serum PSPH was positively correlated with CXCL2 (r=0.420, P<0.05), and both were negatively correlated with the abundance of Firmicutes in the lungs (r=-0.331, P<0.05; r=-0.343, P<0.05), but positively correlated with the abundance of Proteobacteria in the lungs (r=0.292, P<0.05; r=0.388, P<0.001). Multivariate Logistic regression analysis indicated that oxygenation index was a protective factor (P<0.05), while mechanical ventilation duration, SOFA score, PSPH, and CXCL2 levels were risk factors (P<0.05). ROC curve analysis showed that the AUC for predicting prognosis using serum PSPH, CXCL2 alone, and in combination were 0.823 (0.777-0.883), 0.822 (0.772-0.871), and 0.903 (0.869-0.938), respectively. The sensitivity and specificity of combined diagnosis were higher than those of single diagnosis. Conclusion Serum PSPH and CXCL2 levels are closely related to the prognosis and pulmonary microbiota in patients with sepsis-associated ARDS, and can serve as auxiliary indicators for predicting prognosis.

keywords:Sepsis Acute respiratory distress syndrome Phosphoserine phosphatase C-X-C motif chemokine ligand 2 Prognosis

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