输血相关性急性肺损伤患者血清B型钠尿肽的表达水平与肺损伤的相关性分析

Serum B-type natriuretic peptide expression level in patients with blood transfusion-related acute lung injury and its correlation with lung injury

目的探讨输血相关性急性肺损伤(TRALI)患者血清B型钠尿肽(BNP)水平变化及其与肺损伤的相关性分析。方法选择2018年5月至2020年5月四川省岳池县人民医院收治的200例行大量输血患者作为研究对象,按照输血6 h后是否发生TRALI分为TRALI组81例和非TRALI组119例。收集两组患者性别构成、年龄、体质量、吸烟史、原发疾病等一般资料,分别于输血前、输血后6 h采用免疫荧光法检测BNP,采用Murray肺损伤评分系统评定肺损伤程度,测定动脉血气分析指标,并记录血液制品输注量及种类,比较血清BNP水平变化与氧合指数、Murray肺损伤评分和血液制品的相关性。结果两组患者在性别构成、年龄、体质量、吸烟史、氧合指数、原发疾病方面比较差异无统计学意义(P<0.05)。输血后6 h,TRALI组Murray肺损伤评分、血清BNP水平高于非TRALI组[(0.77±0.36)分比(0.07±0.03)分、(82.62±25.13)μg/L比(68.15±20.15)μg/L],氧合指数低于非TRALI组[(249.92±66.29)mmHg(1 mmHg=0.133 kPa)比(323.05±92.30)mmHg],差异有统计学意义(P<0.05)。相关性分析显示,TRALI患者血清BNP水平与Murray肺损伤评分呈正相关(r=0.914,P<0.001),与氧合指数呈负相关(r=-0.883,P<0.001)。TRALI组库存1周以上红细胞悬液输注量、新鲜冰冻血浆输注量高于非TRALI组[(9.92±3.61)U比(7.78±2.81)U、(1635.96±413.88)ml比(1382.15±339.51)ml],而去白红细胞输注量低于非TRALI组[(7.39±2.98)U比(9.40±2.28)U],差异有统计学意义(P<0.05)。相关性分析显示,血清BNP水平与库存1周以上红细胞悬液输注量、新鲜冰冻血浆输注量呈正相关(r=0.719,P<0.001;r=0.736,P<0.001),与去白红细胞输注量呈负相关(r=-0.705,P<0.001)。结论血清BNP水平可作为诊断TRALI的生物标志物,有助于监测病情严重程度,对选择血液制品有指导意义。

Objective To investigate theserum B-type natriuretic peptide(BNP)level in patients with blood transfusion-related acute lung injury(TRALI)and its correlation with lung injury.Methods Two hundredpatients with massive blood transfusions who were admitted to the People′s Hospital of Yuechi County from May 2018 to May 2020 were selected as the research object.According to the occurrence of related acute lung injury after 6 h of blood transfusion,they were divided into the TRALI group(81 cases)and non-TRALI group(119 cases).General data such as gender,age,body weight,smoking history,and primary disease were collected in the two groups.The level of BNP was detected by immunofluorescence before and 6 h after blood transfusion.The degree of lung injury was evaluated by Murray lung injury scoring system.The arterial blood gas indexes of the two groups were measured,and the amount and type of blood product infusion were recorded.Changes in serum BNP level was compared,and their correlations with oxygenation index,Murray lung injury score and blood products were analyzed.Results There was no statistically significant difference between the two groups in terms of gender,age,body weight,smoking history,oxygenation index,primary disease(P>0.05).After 6 h of blood transfusion,the Murray lung injury scores and serum BNP level in the TRALI group were significantly higher than those in the non-TRALI group:(0.77±0.36)scores vs.(0.07±0.03)scores,(82.62±25.13)μg/L vs.(68.15±20.15)μg/L;while the oxygenation index was significantly lower than that in the non-TRALI group:(249.92±66.29)mmHg(1 mmHg=0.133 kPa)vs.(323.05±92.30)mmHg,and the differences were statistically significant(P<0.05).Correlation analysis showed that the serum BNP was positively correlated with Murray lung injury score(r=0.914,P<0.001),and was negatively correlated with oxygenation index(r=-0.883,P<0.001).The infusion volume of erythrocyte suspension over 1 week in stock and fresh frozen plasma infusion in the TRALI group were higher than those in the non-TRALI group:(9.92±3.61)U vs.(7.78±2.81)U,(1635.96±413.88)ml vs.(1382.15±339.51)ml;while the infusion of leukocyte-free was lower than that in the non-TRALI group:(7.39±2.98)U vs.(9.40±2.28)U,and the differences were statistically significant(P<0.05).Correlation analysis showed that serum BNP was positively correlated with the infusion volume of erythrocyte suspension over 1 week in stock and fresh frozen plasma infusion(r=0.719,P<0.001;r=0.736,P<0.001),and was negatively correlated with the infusion volume of leukocyte-free(r=-0.705,P<0.001).Conclusions Serum BNP can be used as a biomarker for diagnosis of blood transfusion-related acute lung injury,which has guiding significance for monitoring the severity of the disease and the selection of blood products.