外周血Th17细胞、降钙素原在急性A型主动脉夹层病人中的表达与急性肺损伤的关系

Expressions of T help 17 cells and procalcitonin in patients with acute type A aortic dissection and the relationship with acute lung injury

目的探讨外周血Th17细胞、降钙素原(PCT)在急性A型主动脉夹层病人中的表达与急性肺损伤的关系。方法选择我院2014年12月至2017年12月间120例急性A型主动脉夹层病人为研究对象,依据病人是否发生肺损伤分为肺损伤组和非肺损伤组。收集病人的临床资料并对病人进行急性生理学与慢性健康状况(APACHEⅡ)评分,检测并比较2组外周血PCT水平和Th17细胞比例,并分析其与肺损伤的相关性,应用Logistic回归模型进行多因素分析,绘制受试者工作特征(ROC)曲线计算外周血PCT水平、Th17细胞比例对急性A型主动脉夹层病人急性肺损伤的诊断效能。结果肺损伤组APACHEⅡ评分、外周血PCT水平及Th17细胞比例均明显高于非肺损伤组(P<0. 05);外周血PCT水平、Th17细胞比例与APACHEⅡ评分呈显著正相关(r=0. 71、0. 67,P<0. 01);多因素Logistic回归分析显示,APACHEⅡ(OR=2. 387,95%CI:2. 164～2. 633)、PCT(OR=1. 354,95%CI:1. 017～1. 802)、Th17细胞比例(OR=1. 740,95%CI:0. 762～3. 972)均为急性A型主动脉夹层病人发生肺损伤的独立危险因素(P<0. 05)。ROC曲线结果表明外周血PCT、Th17细胞比例及二者联合应用诊断急性A型主动脉夹层病人肺损伤的曲线下面积分别为0. 794(95%CI:0. 739～0. 849)、0. 767(95%CI:0. 711～0. 823)、0. 907(95%CI:0. 871～0. 942),对应的诊断灵敏度分别为86. 5%、81. 1%、78. 4%,特异度分别为83. 1%、85. 5%、95. 2%。结论外周血Th17细胞比例、PCT水平可作为急性A型主动脉夹层病人肺损伤病情诊断的重要监测指标。

Objective To explore the expressions of T help 17 cell(Th17)and procalcitonin(PCT)in patients with acute type A aortic dissection and the relationship with acute lung injury(ALI).Methods A total of 120 patients with acute type A aortic dissection in our hospital from December 2014 to December 2017 were enrolled,and the patients were divided into ALI group and non-ALI group according to whether the lung injury occurred.Clinical data of the patients were collected and the acute physiology and chronic health status(APACHEⅡ)score was assessed in all patients,and the levels of PCT and Th17 in peripheral blood were detected and compared between the two groups.The relationship of PCT level and Th17 cell ratio with ALI was analyzed.Logistic regression model was used in multiple factors analysis,and the receiver operator characteristic(ROC)curve was made to evaluate the diagnostic efficacy of the PCT level and Th17 cell ratio on ALI in the patients with acute type aortic dissection.Results The APACHEⅡscore,the levels of PCT and Th17 in ALI group were significantly higher than those in non-lung injury group(P<0.05).The PCT level and Th17 cell ratio were significantly positively correlated with APACHEⅡscore(r=0.71,0.67,P<0.01).Multi-factor logistic regression analysis showed that APACHEⅡscore(OR=2.387,95%CI:2.164-2.633),PCT level(OR=1.354,95%CI:1.017-1.802),Th17 cell ratio(OR=1.740,95%CI:0.762-3.972)were independent risk factors for ALI in the patients with acute type A aortic dissection(P<0.05).The results of ROC curve showed that the AUC of peripheral blood PCT level,Th17 cells ratio and their combined application in diagnosing ALI in the patients with acute type A aortic dissection was 0.794(95%CI:0.739-0.849),0.767(95%CI:0.711-0.823),0.907(95%CI:0.871-0.942).The senstivety of PCT level,Th17 cell ratio and their combined application in diagnosing ALI in patients with acute type A aortic dissection was 86.5%,81.1%,78.4%,and the specificity was 83.1%,85.5%,95.2%respectively.Conclusions The peripheral blood PCT level and Th17 cells ratio can be used as important clinical monitoring indicators for the diagnosis of ALI in the patients with acute type A aortic dissection.