劳力性热射病患者预后的影响因素分析及入院时血清TNF-α、HMGB1、CCL5对死亡风险的预测价值研究

Analysis of Influencing Factors on Prognosis of Patients with Exertional Heat Stroke and Study of Predictive Value of Serum TNF-α,HMGB1 and CCL5 at Admission on the Risk of Death

目的:探讨劳力性热射病(EHS)患者预后的影响因素,并分析入院时血清肿瘤坏死因子-α(TNF-α)、高迁移率族蛋白1(HMGB1)、CC类趋化因子5(CCL5)对该病患者死亡风险的预测价值。方法:选取2018年5月~2022年4月我院收治的50例EHS患者,入院时均以酶联免疫吸附试验完善血清TNF-α、HMGB1、CCL5水平检测。以康复或死亡为观察终点,将患者分成存活组(32例)和死亡组(18例),采用多因素Logistic回归分析患者预后的影响因素。利用接收者工作特征(ROC)曲线分析入院时血清TNF-α、HMGB1、CCL5对患者死亡风险的预测价值。结果:死亡组血清TNF-α、HMGB1、CCL5水平均高于存活组(P<0.05)。死亡组入院时体温、心率、急性生理与慢性健康评分系统II(APACHE II)评分、血钠、血钾、血钙、肌红蛋白、谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮、肌酐、总胆红素水平均高于存活组,收缩压、舒张压、指脉氧均低于存活组(P<0.05)。多因素Logistic回归分析显示,入院时血清TNF-α、HMGB1、CCL5水平较高是EHS患者死亡的危险因素(P<0.05)。ROC曲线分析显示,入院时联合检测血清TNF-α、HMGB1、CCL5三项指标预测EHS患者死亡风险的曲线下面积(0.95CI)为0.869(0.739~0.975),预测效能较好。结论:入院时血清TNF-α、HMGB1、CCL5水平较高是EHS患者预后的不利影响因素,且联合检测上述三指标对患者的死亡风险有一定预测价值。

Objective:To influencing factors on prognosis of patients with exertional heat stroke(EHS),and to analyze the predictive value of serum tumor necrosis factor-α(TNF-α),high mobility group protein 1(HMGB1) and CC-like chemokine 5(CCL5) at admission on the risk of death of patients with EHS.Methods:50 patients with EHS who were admitted to our hospital from May 2018 to April 2022 were selected,and serum TNF-α,HMGB1 and CCL5 levels at admission were detected by enzyme-linked immunosorbent assay.With recovery or death as the observation end point,patients were divided into survival group(32 cases) and death group(18 cases),and multivariate Logistic regression was used to analyze the influencing factors of patients’ prognosis.The predictive value of serum TNF-α,HMGB1 and CCL5 on the risk of death was analyzed by receiver operating characteristic(ROC) curve.Results:The TNF-α,HMGB1and CCL5 levels in the death group were higher than those in the survival group(P<0.05).Body temperature,heart rate,Acute physiology and chronic health scoring system II(APACHE II) score,blood sodium,blood potassium,blood calcium,myoglobin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea nitrogen,creatinine and total bilirubin levels in death group were higher than those in survival group.Systolic blood pressure,diastolic blood pressure and finger pulse oxygen were lower than those in survival group(P<0.05).Multivariate Logistic regression analysis showed that higher levels of TNF-α,HMGB1 and CCL5 at admission were risk factors for death of patients with EHS(P<0.05).ROC curve analysis showed that the area under the curve(0.95CI) of combined detection of serum TNF-α,HMGB1 and CCL5 at admission to predict the risk of death was 0.869(0.739~0.975),indicated a good prediction efficiency.Conclusion:High levels of serum TNF-α,HMGB1 and CCL5 at admission are adverse factors for the prognosis of patients with EHS,and combined detection of these three indicators has certain predictive value for the risk of death of patients.