血清趋化因子受体4与粒细胞集落刺激因子在急性肺损伤患者中变化及对预后的影响

Changes of serum chemokine receptor 4 and granulocyte colony stimulating factor in patients with acute lung injury and their effects on prognosis

目的观察血清趋化因子受体4(CXCR4)与粒细胞集落刺激因子(G-CSF)在急性肺损伤(ALI)患者中的变化及对预后的影响。方法选取2018年1月—2020年6月石家庄市人民医院呼吸科收治的ALI患者92例纳入ALI组,另选同期体检健康者90例纳入健康对照组,检测2组受试者血清CXCR4、G-CSF水平。所有ALI患者入院3个月后,根据预后转归情况分为生存亚组(n=51)与死亡亚组(n=41),采用Logistic回归分析影响ALI预后的相关因素,并以受试者工作特征曲线(ROC)分析血清CXCR4、G-CSF对ALI预后的预测价值。结果ALI组血清CXCR4、G-CSF水平显著高于健康对照组(t/P=28.104/0.001、30.966/0.001)。死亡亚组血清CXCR4、G-CSF水平、APACHEⅡ评分及病因为严重脓毒症占比均高于生存亚组(t/χ^(2)/P=15.545/0.001、13.219/0.001、15.347/0.001、5.125/0.024)。Logistic回归分析显示,血清CXCR4高、G-CSF高、APACHEⅡ评分高及病因为严重脓毒症是影响ALI预后的危险因素[OR(95%CI)=3.264(1.642~5.913)、2.018(1.339~4.712)、2.977(1.608~5.326)、1.885(1.234~3.359)]。ROC分析显示,血清CXCR4、G-CSF及二者联合预测ALI预后的曲线下面积(AUC)分别为0.802、0.779、0.861,二者联合预测优于单独指标(Z/P=3.879/0.001、3.962/0.001)。结论ALI患者血清CXCR4、G-CSF水平升高,血清CXCR4、G-CSF水平升高是影响ALI预后的危险因素,二者联合检测对ALI预后有一定的预测作用。

Objective To observe the changes of serum chemokine receptor 4(CXCR4)and granulocyte colony stimulating factor(G-CSF)in patients with acute lung injury(ALI)and their effects on prognosis.Methods From January 2018 to June 2020,92 patients with ALI admitted to the Respiratory Department of Shijiazhuang People's Hospital were included in the AlI group,and another 90 healthy people who underwent physical examination in the same period were included in the healthy control group.The levels of serum CXCR4 and G-CSF in the two groups were detected.Three months after admission,all patients with ALI were divided into survival subgroup(n=51)and death subgroup(n=41)according to the prognosis.The related factors affecting the prognosis of Ali were analyzed by logistic regression,and the predictive value of serum CXCR4 and G-CSF on the prognosis of Ali was analyzed by receiver operating characteristic curve(ROC).Results The levels of serum CXCR4 and G-CSF in Ali group were significantly higher than those in healthy control group(t/P=28.104/0.001,30.966/0.001).The levels of serum CXCR4,G-CSF,ApacheⅡscore and the proportion of severe sepsis in the death subgroup were higher than those in the survival subgroup(t/χ^(2)/P=15.545/0.001,13.219/0.001,15.347/0.001,5.125/0.024).Logistic regression analysis showed that high serum CXCR4,high G-CSF,high ApacheⅡscore and severe sepsis were the risk factors affecting the prognosis of Ali[OR(95%Cl)=3.264(1.642-5.913),2.018(1.339-4.712),2.977(1.608-5.326),1.885(1.234-3.359)].ROC analysis showed that the area under the curve(AUC)of serum CXCR4,G-CSF and their combination in predicting the prognosis of ALI were 0.802,0.779 and 0.861,respectively.The combined prediction of serum CXCR4 and G-CSF was better than that of single index(Z/P=3.879/0.001 and 3.962/0.001).Conclusion The levels of serum CXCR4 and G-CSF in patients with ALI are elevated.The elevated levels of serum CXCR4 and G-CSF are risk factors affecting the prognosis of ALI.The combined detection of the two can predict the prognosis of ALI.