血清sTREM-1、HMGB1用于评估重型颅脑损伤并发肺部感染的临床价值

Values of serum STREM-1 and HMGB1 for evaluating pulmonary infection in patients with severe craniocerebral injury

目的探讨血清可溶性髓系细胞触发受体-1(sTREM-1)和高迁移率族蛋白B1(HMGB1)用于评估重型颅脑损伤并发肺部感染的临床价值。方法选取2017年7月至2019年7月海口市人民医院收治的102例重型颅脑损伤患者,根据肺部感染发生情况分为感染组45例与非感染组57例,并依据术后30 d感染结局情况,将感染组分为生存组37例及死亡组8例。应用酶联免疫吸附试验检测血清sTREM-1、HMGB1水平,同时检测各组患者WBC、降钙素原(PCT)、CRP、TNF-α等指标。并采用ROC曲线分析两项单独检测及联合检测对重型颅脑损伤并发肺部感染的诊断价值,应用多因素logistic回归分析影响患者预后危险因素。结果感染组sTREM-1、HMGB1、体温、WBC、PCT、CRP、TNF-α均较非感染组高(均P<0.05);血清sTREM-1和HMGB1诊断重型颅脑损伤并发肺部感染的最佳临界值分别为108.40 ng/ml、5.08 ng/ml,两者联合诊断的灵敏度为0.944,高于两项单独诊断0.833、0.889;死亡组sTREM-1、HMGB1、WBC、PCT、CRP、TNF-α均较生存组高,而GCS评分较生存组低(均P<0.05);GCS评分、sTREM-1、HMGB1为影响重型颅脑损伤并发肺部感染患者预后的独立危险因素(均P<0.05)。结论重型颅脑损伤并发肺部感染患者血清sTREM-1、HMGB1均显著升高,联合诊断可提高临床诊断价值,且作为影响患者预后的危险因素,临床应及早采取防治措施,控制感染,改善预后。

Objective To investigate the application of serum soluble triggering receptor expressed on myeloid cells-1(sTREM-1)and high mobility group box 1(HMGB1)for evaluating pulmonary infection in patients with severe craniocerebral injury.Methods One hundred and two patients with severe craniocerebral injury admitted to Haikou Municipal Hospital from July 2017 to July 2019 were enrolled.According to the incidence of pulmonary infection,they were divided into infection group(45 cases)and non-infection group(57 cases);and according to the infection outcome at 30 d after operation,infection group was further divided into survival group(37 cases)and fatal group(8 cases).The levels of serum sTREM-1 and HMGB1 were detected by enzyme linked immunosorbent assay,and WBC,PCT,CRP,TNF-αand other indicators were also detected.The ROC curve was used to analyze the diagnostic values of sTREM-1 and/or HMGB1 for pulmonary infection in patients with severe craniocerebral injury;and multivariate logistic regression analysis was used to analyze the risk factors of adverse prognosis.Results The sTREM-1,HMGB1,the body temperature,WBC,PCT,CRP and TNF-αof infection group were higher than those of non-infection group(all P<0.05).Taking 108.40 ng/ml and 5.08 ng/ml as optimal cut-off values of serum sTREM-1 and HMGB1 for diagnosis of pulmonary infection,the sensitivity of the combined two indicators was 0.944,which was higher than that of single indicators(0.833 and 0.889).The sTREM-1,HMGB1,WBC,PCT,CRP and TNF-αin the fatal group were higher than those in the survival group,while the GCS score was lower than that in survival group(P<0.05).The GCS score,sTREM-1 and HMGB1 were independent risk factors for adverse prognosis of severe craniocerebral injury patients complicated with pulmonary infection(P<0.05).Conclusion Serum sTREM-1 and HMGB1 in severe craniocerebral injury patients complicated with pulmonary infection are significantly increased,the combined detection of two indicators can improve the clinical diagnosis value.According to risk factors,relevant clinical measures should be taken as early as possible to control infection and improve the prognosis of patients with severe craniocerebral injury.