脓毒症相关急性肺损伤患者趋化因子受体4、可溶性髓样细胞触发受体样转录因子-1检测价值探讨

Detection value of chemokine receptor 4 and soluble myeloid cell triggered receptor like tran-s cription factor-1in patients with sepsis-related acute lung injury

目的探讨脓毒症相关急性肺损伤(ALI)患者血清趋化因子受体4(CXCR4)、可溶性髓样细胞触发受体样转录因子-1(sTLT-1)水平与预后的关系。方法选取脓毒症相关ALI患者90例(ALI组),脓毒症未出现ALI患者50例(非ALI组),同期健康体检者50例(对照组),ALI患者根据肺损伤程度进一步分为高危组、中危组、低危组,根据临床结局分为死亡组和存活组。分别比较不同分组患者血清CXCR4、sTLT-1水平,分析血清CXCR4、sTLT-1水平与急性生理学与慢性健康状况评分系统II(APACHE II)的相关性,评估血清CXCR4、sTLT-1单独及联合对脓毒症ALI患者不良预后的预测效能。结果对照组、非ALI组、ALI组,低危组、中危组、高危组血清CXCR4、sTLT-1水平均依次升高(P<0.05);死亡组血清CXCR4、sTLT-1水平均高于存活组(P<0.05);CXCR4、sTLT-1与APACHE II评分呈正相关(P<0.05);血清CXCR4、sTLT-1水平单独及联合预测ALI患者不良预后的敏感度/特异度分别为84.20%/69.00%、73.70%/64.80%、94.70%/60.60%,对应的AUC分别为0.787、0.766、0.854。结论脓毒症ALI患者血清CXCR4、sTLT-1表达上调与病情及预后相关。

Objective To explore the relationship between the serum levels of chemokine C-X-C-motif receptor 4(CXCR4)and soluble myeloid cell triggered receptor like transcription factor-1(sTLT-1)and the prognosis in patients with sepsis complicated with acute lung injury(ALI).Methods Ninety patients with sepsis and ALI were selected as an ALI group,50 patients with sepsis without ALI were enrolled as a non-ALI group,and another 50 healthy people with physical examination during the same period were included in a control group.The patients with ALI were further divided into a high-risk group,a middle-risk group and a low-risk group according to the degree of lung injury.According to clinical outcome,these patients were classified into a death group and a survival group.The levels of serum CXCR4 and sTLT-1 were compared among different groups.The correlation between serum CXCR4 and sTLT-1 levels and score of Acute Physiology and Chronic Health Evaluation II(APACHE II)was analyzed.The predictive efficiency of serum CXCR4 and sTLT-1 alone and in combination on poor prognosis in patients with sepsis and ALI was evaluated.Results The levels of serum CXCR4 and sTLT-1 in the control group,non-ALI group,ALI group,low-risk group,middle-risk group and high-risk group were increased in turn(P<0.05).Serum CXCR4 and sTLT-1 levels in the death group were higher than those in the survival group(P<0.05).Serum CXCR4 and sTLT-1 levels were positively correlated with APACHE II score(P<0.05).The sensitivity of serum CXCR4 and sTLT-1 levels alone and combined to predict the poor prognosis of ALI patients were 84.20%,73.70%and 94.70%and the specificity were 69.00%,64.80%and 60.60%,respectively.The corresponding areas under curves(AUCs)of ROC curve analysis were 0.787,0.766 and 0.854,respectively.Conclusions The increased expressions of serum CXCR4 and sTLT-1 in patients with sepsis and ALI are associated with the disease condition and prognosis.