血浆单核细胞趋化蛋白1、可溶性髓系细胞触发受体1及高迁移率族蛋白B1水平对急性肺损伤患者病情及预后的评估价值

Value of plasma monocyte chemoattractant protein-1,soluble triggering receptor expressed on myeloid cells-1 and high mobility group box 1 in evaluating the condition and prognosis of patients with acute lung injury

目的探讨血浆单核细胞趋化蛋白1(MCP-1)、可溶性髓系细胞触发受体1(sTREM-1)及高迁移率族蛋白B1(HMGB1)水平对急性肺损伤(ALI)患者病情及预后的评估价值。方法选取2016年1月至2019年12月海口市第三人民医院收治的120例ALI患者,根据ALI患者生存情况分为存活组(78例)和死亡组(42例)。记录所有患者的年龄、性别、体质量指数、基础疾病、心率、呼吸频率、呼气末正压、急性病生理学和长期健康评价(APACHE)Ⅱ评分、血浆MCP-1、sTREM-1及HMGB1水平等一般资料。采用多因素Logistic回归分析影响ALI患者预后的独立危险因素。采用受试者工作特征(ROC)曲线分析血浆MCP-1、sTREM-1及HMGB1水平对ALI患者预后的预测价值,并用Z检验比较其曲线下面积(AUC)。采用Pearson相关分析探讨ALI患者血浆MCP-1、sTREM-1及HMGB1水平与APACHEⅡ评分的相关性。结果死亡组患者呼气末正压[(14.2±3.7)cmH2O vs.(9.4±2.9)cmH2O]、APACHEⅡ评分[(27±6)分vs.(14±4)分]、血浆MCP-1[(41±7)ng/L vs.(28±5)ng/L]、sTREM-1[(73±11)ng/L vs.(49±6)ng/L]及HMGB1[(43±12)μg/L vs.(18±5)μg/L]水平均明显高于存活组(t=7.226、9.813、10.252、13.805、12.724,P均<0.001)。多因素Logistic回归分析结果显示,APACHEⅡ评分[比值比(OR)=2.973,95%置信区间(CI)(2.120,6.215),P=0.013]、MCP-1[OR=2.216,95%CI(1.552,4.517),P<0.001]、sTREM-1[OR=2.550,95%CI(1.713,5.106),P<0.001]及HMGB1[OR=1.894,95%CI(1.172,3.195),P<0.001]水平是影响ALI患者预后的独立危险因素。ROC曲线分析结果显示,APACHEⅡ评分[AUC=0.770,95%CI(0.712,0.834),P=0.012]、MCP-1[AUC=0.812,95%CI(0.756,0.873),P<0.001]、sTREM-1[AUC=0.840,95%CI(0.781,0.902),P<0.001]、HMGB1[AUC=0.793,95%CI(0.734,0.851),P=0.005]及四项联合[AUC=0.926,95%CI(0.870,0.988),P<0.001]均对ALI患者预后具有预测价值,且四项联合的AUC明显高于单项APACHEⅡ评分(Z=5.938,P<0.001)、MCP-1(Z=5.310,P=0.006)、sTREM-1(Z=4.783,P=0.013)及HMGB1(Z=5.672,P<0.001)。Pearson相关分析结果显示,ALI患者血浆MCP-1、sTREM-1及HMGB1水平与APACHEⅡ评分均呈正相关(r=0.783、0.824、0.750,P均<0.001)。结论MCP-1、sTREM-1及HMGB1水平与ALI患者病情严重程度及预后相关,联合APACHEⅡ评分对预测ALI患者预后具有较好的价值。

Objective To investigate the value of plasma monocyte chemoattractant protein-1(MCP-1),soluble triggering receptor expressed on myeloid cells-1(sTREM-1)and high mobility group box 1 (HMGB1) levels in evaluating the condition and prognosis of patients with acute lung injury (ALI). Methods A total of 120 patients with ALI admitted to the Third People's Hospital of Haikou City from January 2016 to December 2019 were divided into asurvival group (n = 78) and a death group (n = 42) according to their survival status. The age, gender, body mass index, underlying disease, heart rate, respiratory rate, positive end-expiratory pressure, acute physiology and chronic health evaluation (APACHE) Ⅱ score, plasma MCP-1, sTREM-1 and HMGB1 were recorded for all patients. Multivariate Logistic regression was used to analyze independent risk factors affecting the prognosis of patients with ALI. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of plasma MCP-1, sTREM-1 and HMGB1 levels on their prognosis, and the area under the curve (AUC) was compared by the Z test. Pearson correlation was used to investigate the correlation between the plasma MCP-1, sTREM-1, HMGB1 and APACHE Ⅱ score in patients with ALI. Results The levels of end-expiratory positive pressure [(14.2 ± 3.7) cmH2O vs. (9.4 ± 2.9) cmH2O], APACHE Ⅱ score [(27 ± 6) vs. (14 ± 4)], plasma MCP-1 [(41 ± 7) ng / L vs. (28 ± 5) ng / L], sTREM-1 [(73 ±11) ng / L vs. (49 ± 6) ng / L] and HMGB1 [(43 ± 12) μg / L vs. (18 ± 5) μg / L] in the death group were significantly higher than those in the survival group (t = 7.226, 9.813, 10.252, 13.805, 12.724;all P < 0.001). Multivariate Logistic regression analysis showed that the APACHE Ⅱ score [odds ratio (OR) = 2.973, 95% confidence interval (CI) (2.120, 6.215), P = 0.013], MCP-1 [OR = 2.216, 95%CI (1.552, 4.517), P < 0.001], sTREM-1 [OR = 2.550, 95%CI (1.713, 5.106), P < 0.001] and HMGB1 [OR = 1.894, 95%CI (1.172, 3.195), P < 0.001] were independent risk factors for the prognosis of patients with ALI. ROC curve analysis showed that the APACHE Ⅱ score [AUC = 0.770, 95%CI (0.712, 0.834), P = 0.012], MCP-1 [AUC = 0.812, 95%CI (0.756, 0.873), P < 0.001], sTREM-1 [AUC = 0.840, 95%CI (0.781, 0.902), P < 0.001], HMGB1 [AUC = 0.793, 95%CI (0.734, 0.851), P = 0.005] and the four combinations [AUC = 0.926, 95%CI (0.870, 0.988), P < 0.001] all had predictive value for their prognosis, and the AUC of the four combinations was significantly higher than the single APACHE Ⅱ score (Z = 5.938, P < 0.001), MCP-1 (Z = 5.310, P = 0.006), sTREM-1 (Z = 4.783, P = 0.013) and HMGB1 (Z = 5.672, P < 0.001). Pearsoncorrelation analysis showed that the plasma MCP-1, sTREM-1 and HMGB1 levels were positively correlated with APACHE Ⅱ scores in patients with ALI (r = 0.783, 0.824, 0.750;all P < 0.001). Conclusion The MCP-1, sTREM-1 and HMGB1 levels are correlated with the severity andprognosis of patients with ALI, and their combinations with the APACHE Ⅱ score have good value in predicting the prognosis.