血清CXCR4和HMGB1水平在预测急性大出血患者输血相关性急性肺损伤预后中的价值研究

Value of serum CXCR4 and HMGB1 levels in predicting the prognosis of transfusion-related acute lung injury in patients with acute massive hemorrhage

目的研究血清趋化因子受体4(CXCR4)与高迁移率蛋白B1(HMGB1)水平在预测急性大出血患者输血相关疾病肺损伤(TRALI)患者预后中的价值。方法回顾性将2019年1月至2022年1月间洪湖市中医医院收治的因急性大出血输血引发TRALI的63例患者纳为观察组,同期大出血输血未并发TRALI的60例患者纳为对照组。并根据观察组48 h内生存情况将其分为死亡组(n=11)与存活组(n=52)。检测并比较观察组与对照组、观察组不同预后患者血清CXCR4及HMGB1水平,绘制受试者工作特征(ROC)曲线分析血清CXCR4及HMGB1水平在预测TRALI患者预后中的价值。结果观察组患者血清CXCR4及HMGB1水平为(276.54±35.15)ng/L、(92.46±19.52)μg/L,均高于对照组[(183.64±20.79)ng/L、(56.89±16.44)μg/L],差异均有统计学意义(P<0.05)。TRALI死亡组患者血清CXCR4及HMGB1水平为(382.66±37.15)ng/L、(133.02±17.52)μg/L,均高于存活组[(254.09±21.66)ng/L、(88.11±12.68)μg/L],差异均有统计学意义(P<0.05)。绘制ROC曲线发现,血清HMGB1在预测TRALI患者死亡中的效能略高于CXCR4,其曲线下面积(AUC)为0.796,95%CI(0.644~0.948),两指标联合应用能有效提高各指标单独应用时的预测效能,AUC为0.955,95%CI(0.902~1.000)。结论并发TRALI的输血患者血清CXCR4及HMGB1水平异常升高,且TRALI死亡者血清CXCR4及HMGB1水平高于存活者,两种血清指标在预测TRALI死亡风险中具有一定的价值。

Objective To investigate the value of serum chemokine receptor gene(CXCR4)and high mobility group protein B1(HMGB1)levels in predicting the prognosis of transfusion-related acute lung injury(TRALI)in patients with acute massive hemorrhage.Methods Sixty-three patients with acute massive hemorrhage induced TRALI in Honghu Hospital of Traditional Chinese Medicine from January 2019 to January 2022 were retrospectively enrolled as observation group,meantime,another 60 patients with acute massive hemorrhage and no TRALI were set as control group.The observation group was further divided into death group(n=11)and survival group(n=52)according to the survival situation within 48 hours.Serum CXCR4 and HMGB1 levels were detected,and the levels were compared between two groups and within observation group.receiver operating characteristic(ROC)curve was drawn to analyze the value of serum CXCR4 and HMGB1 levels in predicting the prognosis of patients with TRALI.Results The levels of serum CXCR4 and HMGB1 in the observation group were(276.54±35.15)ng/L,(92.46±19.52)μg/L,which were higher than those in the control group[(183.64±20.79)ng/L,(56.89±16.44)μg/L],the differences were statistically significant(P<0.05).The levels of serum CXCR4 and HMGB1 in the death group were(382.66±37.15)ng/L,(133.02±17.52)μg/L,which were higher than those in the survival group[(254.09±21.66)ng/L,(88.11±12.68)μg/L]L],the differences were statistically significant(P<0.05).ROC curve found that serum HMGB1 was slightly more effective than CXCR4 in predicting death in patients with TRALI,with an area under the curve(AUC)was 0.796,95%CI(0.644-0.948).The combined detection of CXCR4 and HMGB1 achieved higher predictive efficacy than that of separate detection,with an AUC was 0.955,95%CI(0.902-1.000).Conclusion Patients with acute massive hemorrhage complicating TRALI have abnormally elevated serum CXCR4 and HMGB1 levels,moreover,the serum CXCR4 and HMGB1 levels are higher in those who died from TRALI than in those who survived,making both serum indicators valuable in predicting the risk of death of TRALI.