肺挫伤后肺特异性相关蛋白血清 CC16变化的临床研究

Clinical study on the changes of lung specific protein-CC16 after lung contusion

目的：探讨血清肺特异性相关蛋白克拉拉蛋白16（ CC16）浓度的连续监测对诊断肺挫伤、评估其严重程度及预判疾病进展的临床价值。方法选择经胸部CT确诊有肺挫伤的急性创伤患者31例，分别于伤后第3、5、7天复查胸部CT，应用体积计算程序得出肺挫伤体积，同时观察记录肺不张、胸腔积液等相关并发情况。所有患者连续7 d采集血标本测定血清CC16浓度。另取15名健康志愿者血标本检测值作为正常参考值。进一步对血清CC16浓度与肺挫伤体积及其变化程度做相关分析。结果所有肺挫伤患者血清CC16浓度均明显高于正常参考值，且在首日即达峰值。 CT显示，肺挫伤受损范围会逐渐增大并有肺不张和胸腔积液相关并发症发生。病程中最大肺挫伤体积与7 d内血清CC 16浓度均值和初始血清CC16浓度均呈正相关关系，肺挫伤体积的变化程度与初始CC16浓度存在正相关关系。结论创伤后血清CC 16浓度的升高对诊断肺挫伤有参考价值，高水平的CC16浓度预示着挫伤程度严重并有进一步进展的可能，血清CC16浓度监测可为临床决策提供依据。

Objective To explore the clinical value of continuously monitoring serum CC 16 levels in diagnosing pulmonary contusion , estimating its severity degree and predicting disease progression.Methods Thirty -one acute trauma patients with lung contusion diagnosed by chest computed tomography were included , and reexamined chest CT on day 3, 5 and 7 after injury.Total contusion volume was calculated by the Siemens syngo volume calculation program .Complications like pleural effusion or atelectasis were observed and recorded .Enzyme-linked immunoassay （ ELISA） was employed for measuring the levels of CC 16 in all patients for seven days , another 15 serum were taken from healthy volunteers to provide the reference value .Correlation analysis was further conducted for the CC16 levels and pulmonary contusion volume and its variations .Results Serum concentrations of CC 16 in all lung contusion patients were significantly higher than those in controls , and reached a peak value on the first day , but contusion damage area shown in CT gradually increased with the occurrence of atelectasis and pleural effusion .Maximum volume of lung contusion had a positive correlation to the initial and the average concentrations of CC 16, changes in contusion volume were positively correlated with the initial concentration .Conclusion The increased concentration of CC 16 after lung contusion have important reference for diagnosis , and may portend the the possibility of further progress , continuously monitoring CC 16 serum levels in patients may provide the basis for clinical decision -making .