创伤性肺损伤患者外周血PCT、HMGB-1、ICAM-1水平及对预后的预测价值

Expression levels of peripheral blood PCT, HMGB-1 and ICAM-1 in patients with traumatic lung injury and their prognostic value

目的检测创伤性肺损伤患者外周血降钙素原(PCT)、高迁移率族蛋白1(HMGB-1)和细胞间黏附分子-1(ICAM-1)水平并探讨其对预后的预测价值。方法创伤性肺损伤患者78例为观察组,同期创伤未并发肺损伤患者53例为对照组,比较2组患者急性生理与慢性健康(APACHEⅡ)评分、肺损伤评分、创伤严重程度评分差异;酶联免疫吸附试验(ELISA)法检测外周血PCT、HMGB-1和ICAM-1水平,分析其与APACHEⅡ、肺损伤评分的相关性;以观察组患者预后情况分为预后良好组和预后不良组,比较2组患者PCT、HMGB-1和ICAM-1水平变化,受试者工作特征(ROC)曲线分析其对患者不良预后的预测价值。结果观察组APACHEⅡ评分、肺损伤评分、创伤严重程度评分和外周血PCT、HMGB-1、ICAM-1水平高于对照组(P<0.05);外周血PCT、HMGB-1和ICAM-1水平与APACHEⅡ评分、肺损伤评分均呈正相关(P<0.01);预后不良组外周血PCT、HMGB-1和ICAM-1水平高于预后良好组(P<0.01);PCT、HMGB-1、ICAM-1及其联合预测不良预后的ROC曲线下面积(AUC)分别为0.801(0.695~0.907)、0.736(0.618~0.855)、0.821(0.707~0.936)和0.938(0.885~0.991),敏感度分别为0.810、0.762、0.667和0.905,特异度分别为0.719、0.632、0.860和0.842。结论创伤性肺损伤患者外周血PCT、HMGB-1、ICAM-水平升高,联合检测对不良预后具有较高的预测价值。

Objective To explore the expression levels of peripheral blood procalcitonin(PCT),high mobility group box-1 protein(HMGB-1)and intercellular adhesion molecule-1(ICAM-1)in patients with traumatic lung injury and their relationship with prognosis.Methods A total of 78 patients with traumatic lung injury were enrolled as the observation group,while other 53 patients without lung injury were enrolled as the control group.The scores of Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ),lung injury and trauma severity were compared between the two groups.The levels of peripheral blood PCT,HMGB-1 and ICAM-1 were detected by enzyme-linked immunosorbent assay(ELISA),and their relationship with scores of APACHEⅡand lung injury was analyzed.According to the patient’s prognosis,patients in the observation group were divided into the good prognosis group and the poor prognosis group.The changes of PCT,HMGB-1 and ICAM-1 were compared between the two groups.Their relationship with poor prognosis was analyzed by receiver operating characteristic(ROC)curves.Results The scores of APACHEⅡ,lung injury and trauma severity,and levels of peripheral blood PCT,HMGB-1 and ICAM-1 were significantly higher in the observation group than those in the control group(P<0.05).The levels of peripheral blood PCT,HMGB-1 and ICAM-1-were positively correlated with APACHEⅡand lung injury scores(P<0.05).The levels of peripheral blood PCT,HMGB-1 and ICAM-1 were significantly higher in the poor prognosis group than those in the good prognosis group(P<0.05).The area under the ROC curve(AUC)for poor prognosis of PCT,HMGB-1,ICAM-1 and their combined detection were 0.801(0.695-0.907),0.736(0.618-0.855),0.821(0.707-0.936)and 0.938(0.885-0.991).The sensitivity values-were 0.810,0.762,0.667 and 0.905,and the specificity values-were 0.719,0.632,0.860 and 0.842.Conclusion The levels of peripheral blood PCT,HMGB-1 and ICAM-1 are increased in patients with traumatic lung injury,and the combined detection of the three indexes is of high predictive value for the poor prognosis.