FEER、NEU%、IL-6、RBC-C3bR在脑梗死继发Ⅲ、Ⅳ度褥疮感染患者中表达及与预测创面愈合的价值研究

Expression of FEER,NEU%,IL-6,RBC-C3bR in patients withⅢandⅣdegree bedsore infection secondary to cerebral infarction and their value in predicting wound healing

目的探讨免疫黏附促进因子(forming enhancement rosetterate,FEER)、中性粒细胞百分比(neutrophil%,NEU%)、白细胞介素6(interleukin-6,IL-6)、红细胞C3b受体花环率(erythrocyte C3b receptor wreath rate,RBC-C3bR)在脑梗死继发Ⅲ、Ⅳ度褥疮感染患者中表达及对创面愈合的预测价值。方法选取北京市房山区良乡医院收治的43例脑梗死继发Ⅲ度褥疮感染者(Ⅲ度组)、43例脑梗死继发Ⅳ度褥疮感染者(Ⅳ度组)及43例正常人群(对照组),比较各组一般资料、FEER、NEU%、IL-6、RBC-C3bR水平,采用Spearman分析FEER、NEU%、IL-6、RBC-C3bR与褥疮分度的关系,比较创面愈合与未愈合者治疗前、治疗10 d和20 d FEER、NEU%、IL-6、RBC-C3bR水平及褥疮愈合计分量表(pressure ulcer scale for healing,PUSH)评分,采用Pearson分析FEER、NEU%、IL-6、RBC-C3bR与PUSH评分的相关性,采用受试者工作特征曲线(receiver operating characteristic,,ROC)及ROC下面积(area under the curve,AUC)分析各指标预测创面愈合的价值。结果FEER、RBC-C3bR:Ⅳ度组<Ⅲ度组<对照组,NEU%、IL-6:Ⅳ度组>Ⅲ度组>对照组,组间比较差异有统计学意义(P<0.05);FEER、RBC-C3bR与褥疮分度呈负相关,NEU%、IL-6与褥疮分度呈正相关(P<0.05);治疗10 d后创面愈合者FEER、RBC-C3bR呈升高趋势,NEU%、IL-6呈降低趋势,且治疗20 d各指标与治疗10 d比较,差异有统计学(P<0.05);创面未愈合者治疗10 d FEER、RBC-C3bR高于治疗前,NEU%、IL-6低于治疗前(P<0.05),但治疗20 d各指标与治疗10 d各指标比较,差异无统计学意义(P>0.05);创面愈合者治疗10 d、20 d FEER、RBC-C3bR高于未愈合者,NEU%、IL-6低于未愈合者(P<0.05);治疗10 d与20 d FEER、RBC-C3bR与PUSH评分呈负相关,NEU%、IL-6与PUSH评分呈正相关(P<0.05),治疗10 d的相关性强于治疗20 d;预测创面愈合的AUC:IL-6(0.823)>NEU%(0.819)>FEER(0.714)>RBC-C3bR(0.709),各指标联合为0.896(P<0.05)。结论脑梗死继发Ⅲ、Ⅳ度褥疮感染患者治疗前FEER、RBC-C3bR表达显著降低,NEU%、IL-6表达显著升高,治疗后FEER、RBC-C3bR升高及NEU%、IL-6降低可预示创面趋于愈合,检测治疗后10 d各指标水平有望成为预测创面愈合的生物标志物。

Objective To investigate the expression of forming enhancement rosette rate(FEER),neutrophil%(NEU%),interleukin-6(IL-6),and erythrocyte C3b receptor wreath rate(RBC-C3bR)in patients withⅢandⅣdegree bedsore infection secondary to cerebral infarction and their predictive value in wound healing.Methods A total of 43 patients withⅢdegree bedsore infection secondary to cerebral infarction(Ⅲdegree group),43 patients withⅣdegree bedsore infection secondary to cerebral infarction(Ⅳdegree group)and 43 healthy people(control group)were selected from Liangxiang Hospital of Fangshan District in Beijing.The general data,FEER,NEU%,IL-6,and RBC-C3bR levels of each group were compared,and Spearman correlation analysis was used to analyze the relationship between FEER,NEU%,IL-6,RBC-C3bR and the degree of bedsore.The FEER,NEU%,IL-6,RBC-C3bR levels and the Pressure Ulcer Scale for Healing(PUSH)scores of patients with healed and unhealed wound before treatment,at 10 d and 20 d after treatment were compared.Pearson analysis was used to analyze the correlation between FEER,NEU%,IL-6,RBC-C3bR and PUSH score,and receiver operating characteristic curve(ROC)and area under ROC(AUC)were used to analyze the value of each index in predicting wound healing.Results FEER and RBC-C3bR were the lowest inⅣdegree group,followed byⅢdegree group and control group,while NEU%and IL-6 were the highest inⅣdegree group,followed byⅢdegree group and control group,suggesting significant difference between groups(P<0.05).FEER and RBC-C3bR were negatively correlated with the degree of bedsore,and NEU%and IL-6 were positively correlated with the degree of bedsore(P<0.05).At 10 d after treatment,the FEER and RBC-C3bR of the patients with healed wound showed an increasing trend,and the NEU%and IL-6 showed a decreasing trend;there were statistically significant differences between the indicators at 20 d after treatment and those at 10 d after treatment(P<0.05).The FEER and RBC-C3bR of patients with unhealed wounds at 10 d after treatment were higher than those before treatment,and NEU%and IL-6 were lower than those before treatment(P<0.05).However,there was no statistically significant difference between the indexes at 20 d after treatment and those at 10 d after treatment(P>0.05).The FEER and RBC-C3bR of patients with healed wound were higher than those of patients with unhealed wound at 10 d and 20 d after treatment,and the NEU%and IL-6 were lower than those of the unhealed(P<0.05).FEER and RBC-C3bR at 10 d and 20 d after treatment were negatively correlated with PUSH score,while NEU%and IL-6 were positively correlated with PUSH score(P<0.05),and the correlation at 10 d after treatment was stronger than that at 20 d after treatment.The AUC for predicting wound healing was the largest in IL-6(0.823),followed by NEU%(0.819),FEER(0.714)and RBC-C3bR(0.709),and the AUC of the combination of indicators was 0.896(P<0.05).Conclusion The expressions of FEER and RBC-C3bR in patients withⅢandⅣdegree bedsore infection secondary to cerebral infarction decreased significantly,and the expressions of NEU%and IL-6 increased significantly before treatment.After treatment,the increase of FEER,RBC-C3bR and the decrease of NEU%and IL-6 can indicate that the wound tends to heal.The detection of the level of each index at 10 d after treatment is expected to become a biomarker for predicting wound healing.