生物标志物联合TTS评分对肺挫伤发生ARDS的预测作用

目的：通过检测肺挫伤患者血液中血管性血友病因子（vWF）、肺泡表面相关蛋白D（SP-D）、白介素10（IL-10）、活化蛋白C（APC）的变化，结合胸部创伤严重度评分（TTS），研究上述指标血浆水平及评分在肺挫伤患者早期预测病情及预后评估中的作用。方法回顾分析2012年12月至2013年11月收治的55例患者，记录资料包括损伤严重度评分（ISS）、TTS评分及上述生物标志物值。比较研究评分及生物标志物对肺挫伤发生成人呼吸窘迫综合征（ARDS）的预测价值。结果55例患者中，并发ARDS患者35例（63.7%），非ARDS组20例（36.3%）。ARDS组生物标志物及ISS评分和TTS评分与非ARDS组比较均明显异常，差异有统计学意义（P〈0.05）；生物标志物、生物标志物联合ISS评分、生物标志物联合TTS评分预测ARDS时的曲线下面积（AUC）分别为0.679（95%CI 0.532-0.753），0.764（95%CI 0.672-0.821），0.877（95%CI 0.818-0.916）。这三种预后指标中，生物标志物联合TTS评分对ARDS的预测价值最高。结论TTS评分能反应胸部创伤程度，TTS评分联合生物标志物检测对肺挫伤患者发生ARDS更有预测价值。

ObjectiveTo research the differences of vWF,SP-D,IL-10,APC,TTS score in pulmonary contusion patients,to to explore its values of the early prediction of severity and prognosis in patients with pulmonary contusion.MethodsA total of 55 consecutive patients,December 2012 to November 2013 were enrolled. Clinical data of patients（including ISS、TTS score）and venous blood to detect vWF,SP-D,IL-10, APC were collected within 24 hours of admission.ResultsAmong these 55 patients,there were 35（63.7%）cases classified as ARDS. Significant differences in ISS,TTS,vWF,SP-D,IL-10,APC were found between ARDS group and non-ARDS group（P〈0.05）;The value in predicting ARDS when blood markers combined TTS score was the highest（AUC=0.877）.ConclusionCombination of markers（vWF,SP-D,IL-10, APC）joint TTS score on admission has more predictive values in lung contusion patients occurring ARDS;TTS score predictes poor prognosis in pulmonary contusion patients and is suitable for severity assessment and prediction of outcome.