失血性休克患者血清HMGB1及凝血蛋白酶水平变化与创伤性凝血发生风险的相关性分析

The correlation analysis of serum HMGB1 and thrombin levels and the risk of trauma-induced coagulopathy in hemorrhagic shock patients

目的探讨失血性休克(HS)患者血清高迁移率族蛋白1(HMGB1)及凝血蛋白酶水平变化与创伤性凝血(TIC)发生风险的相关性,分析其对TIC的预测价值。方法选取2017年2月至2019年11月失血性休克患者82例,根据入院后是否发生创伤性凝血分为观察组(TIC组,38例)与对照组(非TIC组,44例)。采用ELISA法检测患者血清HMGB1及凝血蛋白酶水平,Logistic回归分析评估血清HMGB1及凝血蛋白酶水平对HS患者发生创伤性凝血的影响,采用受试者工作曲线(ROC)评估HMGB1及凝血蛋白酶水平在HS患者中发生创伤性凝血风险的预测价值。结果TIC组血清HMGB1含量明显高于非TIC组[(30.05±11.72)ng/mL vs(18.18±4.03)ng/mL,P<0.01];T1C组血清凝血蛋白酶水平明显低于非TIC组[(6.48±1.22)IU/mL vs(10.33±1.77)IU/mL,P<0.01]。二元Logistic回归分析结果表明,HMGB1和凝血蛋白酶是HS患者发生TIC的独立危险因素(P<0.01)。ROC曲线结果表明,HMGB1预测HS患者发生TIC的AUC为0.844(95%CI:0.750〜0.939),灵敏度为76.3%,特异性为88.6%;凝血蛋白酶预测HS患者发生TIC的AUC为0.898(95%CI:0.832〜0.964),敏感度为79.5%,特异性为89.5%.结论血清HMGB1在HS合并TIC患者中的表达水平上升,而凝血蛋白酶表达下降,HMGB1及凝血蛋白酶是引起HS患者发生TIC的高危因素。

[Abstract]Objective To investigate the correlation between serum HMGB1 and thrombin levels and the risk of trauma-induced coagulopathy(TIC)in patients with hemorrhagic shock(HS).The predictive value of HMGB1 and thrombin for TIC were analyzed.Methods 82 cases of patients with hemorrhagic shock were included during February 2017 to November 2019.Patients were divided into observation group(TIC group,38 cases)and control group(non-TIC group,44 cases)according to whether trauma-induced coagulopathy occurred after admission.The serum levels of HMGB 1 and thrombin were detemiincd by ELISA method.The effect of serum HMGB1 and thrombin levels on trauma-induced coagulopathy in patients with hemorrhagic shock were analyzed by using Logistic analysis,and diagnostic values of HMGB 1 and thrombin were reviewed by using ROC curve in trauma-induced coagulopathy patients.Results The serum HMGB1 level in TIC group was significandy higher than that in non-TIC group[(30.05±11.72)ng/mL vs(18.18±4.03)ng/mL],and the difference was statistically significant(P<0.01).The expression of thrombin in TIC group was significantly lower than that in non-TIC group[(6.48±1.22)IU/mL vs(10.33±1.77)IU/mL],and the difference was statistically significant(P<0.01).Binary logistic regression analysis showed that HMGB1 and thrombin were independent risk factors for trauma-induced coagulopathy in patients with hemorrhagic shock(P<0.01).The ROC curve showed that the AUC of HMGB 1 in predicting the occurrence of trauma-induced coagulopathy in HS patients was 0.844(95%CI:0.750~0.939),the sensitivity and specificity were 76.3%and 88.6%respectively.The AUC of thrombin in predicting the occurrence of trauma-induced coagulopathy in HS patients was 0.898(95%CI:0.832~0.964),the sensitivity and specificity were 79.5%and 89.5%respectively.Conclusion The expression of HMGB1 in patients with hemorrhagic shock complicated with trauma-induced coagulopathy Is increased,and the expression of thrombin Ls decreased.HMGB1 and thrombin are the high risk factors of trauma-induced coagulopathy in patients with hemorrhagic shock.