摘要
目的 探讨胸部创伤患者术后早期血清中血清淀粉样蛋白A(SAA)、胆碱酯酶(ChE)含量与术后感染的关系.方法 选取2021年12月至2023年5月于湖北省荆州市监利市人民医院手术治疗的114例胸部创伤患者,男性58例,女性56例,年龄(46.23±5.86)岁,年龄范围为33～60岁.检测患者术前1 d、术后第2天及术后第7天SAA水平、ChE水平、C反应蛋白(CRP)水平、降钙素原水平、肿瘤坏死因子-α(TNF-α)水平,中性粒细胞/淋巴细胞计数(NLR)、血小板计数/淋巴细胞计数(PLR)、血小板计数×中性粒细胞计数/淋巴细胞计数(SII)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM),评估患者术后第7天继发感染情况.结果 术后第7天,继发感染患者39例,未继发感染患者75例.未继发感染患者NLR、SII、NEUT、CRP、降钙素原、TNF-α水平低于继发感染患者,PLR、LYM水平高于继发感染患者,差异有统计学意义(P＜0.05).术后第2天,继发感染患者SAA水平高于未继发感染患者,ChE水平低于未继发感染患者,差异有统计学意义(P＜0.05).术后第7天,轻度感染患者18例,中度感染患者13例,重度感染患者8例.轻度感染患者、中度感染患者及重度感染患者SAA、ChE水平比较,差异有统计学意义(P＜0.05).血清SAA升高、CRP升高、降钙素原升高为影响患者术后感染情况的独立危险因素(P＜0.05),血清ChE升高为影响患者术后感染情况的独立保护因素(P＜0.05).联合预测的曲线下面积显著大于血清SAA、ChE单独预测(P＜0.05).SAA与CRP、降钙素原以及TNF-α均呈正相关(P＜0.05);ChE与CRP、降钙素原以及TNF-α均呈负相关(P＜0.05).结论 胸部创伤术后感染患者血清SAA水平升高,ChE水平降低,并且胸部创伤患者术后早期血清中SAA、ChE含量对患者术后感染具有一定辅助预测价值.
Abstract
Objective To explore the relationship between postoperative early serum levels of Serum amyloid A(SAA)and choline esterase(ChE)and postoperative infection in patients with chest trauma.Methods A total of 114 patients with chest trauma who underwent surgical treatment in Jianli People's hospital from December 2021 to May 2023 were collected.There were 58 males and 56 females,age(46.23±5.86)years,age range 33-60 years.The level of SAA,ChE,C-reactive protein(CRP),procalcitonin,tumour necrosis factor-α(TNF-α),neutrophil/lymphocyte count(NLR),platelet count/lymphocyte count(PLR),platelet countxneutrophil count/lymphocyte count(SII),neutrophil granulocyte count(NEUT),lymphocyte count(LYM)were tested on day 1 preoperatively and day 2 postoperatively.Patients were assessed for secondary infections 7 d postoperatively.Results At 7d postoperatively,there were 39 patients with secondary infections and 75 patients without secondary infections.The levels of NLR,SII,NEUT,CRP,procalcitonin,and TNF-α were lower in patients without secondary infection than in patients with secondary infection,and the levels of PLR and LYM were higher than those in patients with secondary infection,with statistically significant differences(P＜0.05).On postoperative day 2,SAA levels were higher in patients with secondary infection than in patients without secondary infection,and ChE levels were lower than in patients without secondary infection(P＜0.05).At 7d postoperatively,there were 18 patients with mild infection,13 patients with moderate infection,and 8 patients with severe infection.Comparison of SAA and ChE levels in mildly infected patients,moderately infected patients and severely infected patients showed statistically significant differences(P＜0.05).Elevated serum SAA,CRP,and procalcitoninlevels were independent risk factors affecting patients postoperative infections(P＜0.05),and elevated serum ChE was an independent protective factor affecting patients postoperative infections(P＜0.05).The area under the curve for the combined prediction was significantly greater than that for serum SAA and ChE alone(P＜0.05).A positive correlation between serum SAA levels and CRP,procalcitoninand TNF-α(P＜0.05),anegative correlation ChE levels and CRP,procalcitoninand TNF-α(P＜0.05).Conclusion Elevated serum SAA levels and decreased ChE levels in patients with postoperative chest trauma infections.The postoperative early serum levels of SAA and ChE in patients with chest trauma have certain prediction value for postoperative infection.
维普
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