摘要
目的 探讨创伤性肺损伤患者的血清降钙素原(PCT)、C反应蛋白(CRP)、高迁移率族蛋白B1(HMGB1)及白细胞介素-6(IL-6)水平对其预后的预测价值.方法 分析2019年6月至2022年6月嘉兴大学附属第二医院急收治的102例创伤性肺损伤患者的临床资料,根据患者入院24 h后是否发展成急性呼吸窘迫综合征(ARDS)或是否在发病28 d内死亡作为预后的分组标准,将患者分为预后良好组(75例)和预后不良组(27例).分别比较两组患者的急性生理与慢性健康(APACHE)评分、急性肺损伤(ALI)评分、格拉斯哥昏迷指数(GCS)评分以及血清PCT、CRP、HMGB1和IL-6水平变化,并进行APACHE Ⅱ评分、ALI评分、GCS评分以及血清PCT、CRP、HMGB1和IL-6水平的Pearson相关性分析;绘制受试者工作特征曲线(ROC),分析血清PCT、CRP、HMGB1和IL-6指标联合检测在预测创伤性肺损伤患者预后中的价值,组间比较采用t或x2检验.结果 预后良好组患者的APACHE Ⅱ评分和ALI评分高于预后不良组[(16.73±3.12)、(1.73±0.51)分比(21.17±3.09)、(1.98±0.66)分,t=6.357、2.015,P＜0.05];预后良好组患者的 GCS 评分低于预后不良组[(6.59±0.83)分比(5.01±0.74)分,=8.717,P＜0.01].预后良好组患者血清 PCT、CRP、HMGB1 和 IL-6 水平均明显低于预后不良组(6.53±2.29、20.09±5.23、22.28±4.33、16.72±4.31比 9.52±1.56、39.18±5.04、26.45±4.31、25.80±8.43,t=6.271、16.417、4.296、7.127,P＜0.01).Pearson相关性分析结果表明,患者入院24 h内的血清PCT、CRP、HMGB1和IL-6水平与APACHE Ⅱ评分呈正相关[(6.53±2.29、20.09±5.23、22.28±4.33、16.72±4.31)比(19.60±5.14、18.73±4.75、18.01±4.63、16.52±4.04),r=0.658、0.539、0.490、0.543,P＜0.01]、与 ALI 评分呈正相关[(6.53±2.29、20.09±5.23、22.28±4.33、16.72±4.31)比(21.93±5.27、19.57±4.62、19.41±4.21、20.82±4.62),r=0.721、0.662、0.617、0.738,P＜0.01]、与 GCS 评分呈负相关[(6.53±2.29、20.09±5.23、22.28±4.33、16.72±4.31)比(-22.06±5.64、-21.03±4.51、-19.56±4.32、-18.53±4.61),r=-0.759、-0.697、-0.536、-0.559,P＜0.01].应用建立的受试者工作特征(ROC)曲线计算各个指标的ACU值,血清四项联合组(PCT、CRP、HMGB1、IL-6)检测时的AUC值均显著高于 PCT、CRP、HMGB1、IL-6 任意单一指标检测[0.922(95％CI:0.863～0.965)比 0.802(95％CI:0.652～0.902)、0.827(95％CI:0.661～0.917)、0.753(95％CI:0.619～0.856)、0.830(95％CI:0.698～0.919),t=0.025、0.053、0.051、0.060、0.059,P＜0.01];血清四项联合组血清四项联合组(PCT、CRP、HMGB1、IL-6)检测时的敏感度和特异度均高于PCT、CRP、HMGB1、IL-6任意单一指标检测[(0.904 和 0.805)比(0.821 和 0.781)、(0.816 和 0.779)、(0.783 和 0.698)、(0.715 和0.734),P＜0.01].结论 创伤性肺损伤患者的血清PCT、CRP、HMGB1和IL-6水平均升高,四项指标联合检测对患者预后的预测价值更高.
Abstract
Objective To investigate the prognostic value of serum procaicitonin(PCT),C-reac-tive protein(CRP),high mobility group box-1 protein(HMGB1)and interleukin-6(IL-6)levels in pa-tients with traumatic lung injury.Methods The clinical data of 102 patients with traumatic lung injury ad-mitted to the Second Affiliated Hospital of Jiaxing University from June 2019 to June 2022 were retrospec-tively.The patients developed acute respiratory distress syndrome 24 h after admission.acute respiratory distress syndrome(ARDS)or whether the patients died within 28 days after the onset of the disease was used as the grouping criteria for prognosis.The patients were divided into good prognosis group(75 cases)and poor prognosis group(27 cases).The changes of acute physiology and chronic health evaluation(APACHE)Ⅱ score,acute lung injury(ALI)score,glasgow coma scale(GCS)score and serum PCT,CRP,HMGB1 and IL-6 levels were respectively compared between the two groups.APACHE Ⅱ score,ALI score,GCS score and serum PCT,CRP,HMGB1 and IL-6 levels were Pearson correlation analysis.receiver operating characteristic curve(ROC)was drawn to analyze the value of combined detection of ser-um PCT,CRP,HMGB1 and IL-6 in predicting the prognosis of patients with traumatic lung injury.The statistical analysis of quantitative data(conforming to normal distribution)is expressed as mean±standard deviation((x)±s)and t-test is used;Count data is presented as an example(％),and comparison between groups is performed using a chi square test.Results The APACHE Ⅱ score and ALI score of patients with good prognosis were higher than those of patients with poor prognosis[(16.73±3.12),(1.73±0.51)points vs.(21.17±3.09),(1.98±0.66)points,t=6.357,2.015,P＜0.05];The GCS score of pa-tients with good prognosis was lower than that of patients with poor prognosis[(6.59±0.83)points vs.(5.01±0.74)points,t=8.717,P＜0.01].The average levels of serum PCT,CRP,HMGB1,and IL-6 in patients with good prognosis were significantly lower than those in patients with poor prognosis(6.53±2.29,20.09±5.23,22.28±4.33,16.72±4.31 vs.9.52±1.56,39.18±5.04,26.45±4.31,and 25.80±8.43,t=6.271,16.417,4.296,and 7.127,P＜0.01).The Pearson correlation analysis re-sults showed that the serum levels of PCT,CRP,HMGB1,and IL-6 in patients within 24 hours of admis-sion were positively correlated with APACHE Ⅱ scores[(6.53±2.29,20.09±5.23,22.28±4.33,16.72±4.31)vs.(19.60±5.14,18.73±4.75,18.01±4.63,6.52±4.04),r=0.658,0.539,0.490,0.543,P＜0.01],and were positively correlated with ALI scores[(6.53±2.29,20.09±5.23,22.28±4.33,16.72±4.31)vs.(21.93±5.27,19.57±4.62,19.41±4.21,20.82±4.62),r=0.721,0.662,0.617,0.738,P＜0.01],and were negatively correlated with GCS scores[(6.53±2.29,20.09±5.23,22.28±4.33,16.72±4.31)vs.(-22.06±5.64,-21.03±4.51,-19.56±4.32,-18.53±4.61),r=-0.759,-0.697,-0.536,-0.559,P＜0.01].The ACU values of each indicator were calculated using the established receiver operating characteristic(ROC)curve.The AUC values of the serum four item combination group(PCT,CRP,HMGB1,IL-6)were significantly high-er than any single indicator detection of PCT,CRP,HMGB1,IL-6:[0.922(95％CI:0.863-0.965)vs.0.802(95％CI:0.652-0.902),0.827(95％CI:0.661-0.917),0.753(95％CI:0.619-0.856),0.830(95％CI:0.698-0.919),t=0.025,0.053,0.051,0.060,0.059,P＜0.01];The sensitivity and specificity of the serum four item combination group(PCT,CRP,HMGB1,IL-6)detection were high-er than any single indicator detection of PCT,CRP,HMGB1,IL-6(0.904 and 0.805 vs.0.821 and 0.781,0.816 and 0.779,0.783 and 0.698,0.715 and 0.734,P＜0.01).Conclusion The average levels of serum PCT,CRP,HMGB1,and IL-6 in patients with traumatic lung injury are elevated,and the combined detection of these four indicators has a higher predictive value for patient prognosis.
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