多发伤患者血清高迁移率族蛋白B1及可溶性髓样细胞触发受体-1水平变化及预后意义

Changes of serum high mobility group box 1 and soluble triggering receptor expressed on myeloid cells-1 in patients with multiple injuries and their prognostic significance

目的·检测多发伤患者不同时间点的血清高迁移率族蛋白B1(high mobility group box 1,HMGB1)及可溶性髓样细胞触发受体-1(soluble triggering receptor expressed on myeloid cell-1,sTREM-1)水平,并分析其与病情严重程度、并发症及预后的相关性。方法·选取2020年12月至2022年12月在苏州市第九人民医院急诊科收治的多发伤患者92例,根据患者入院时的损伤严重程度评分将患者分为轻伤组(n=24)、重伤组(n=58)、严重伤组(n=10);依据入院后是否合并多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)将患者分为MODS组(n=20)和非MODS组(n=72);根据创伤发生后28 d内结局将患者分为死亡组(n=13)和存活组(n=79)。检测患者入院后静脉血炎症因子指标。采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测创伤发生后24 h、72 h及7 d的血清HMGB1、sTREM-1水平。分析不同分组间血清HMGB1、sTREM-1水平的差异,并采用多因素Logistic回归分析多发伤患者不良结局的影响因素。运用受试者工作特征(receiver operating characteristics,ROC)曲线评估HMGB1、sTREM-1对不良结局的预测价值。结果·重伤和严重伤组各时间点HMGB1、sTREM-1水平明显高于轻伤组(均P<0.05),严重伤组创伤发生后72 h和7 d的HMGB1水平及24 h和72 h的sTREM-1水平明显高于重伤组(均P<0.05)。各时间点HMGB1与sTREM-1水平呈正相关性(r=0.645,r=0.942,r=0.722;均P<0.05)。MODS组创伤发生后72 h和7 d的HMGB1水平及24 h和72 h的sTREM-1水平明显高于非MODS组(均P<0.05);死亡组创伤发生后72 h和7 d的HMGB1水平及24 h、72 h的sTREM-1水平明显高于存活组(均P<0.05)。Logistic回归分析显示,创伤发生后7 d的HMGB1水平及入院时间、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平是多发伤患者不良结局的独立影响因素(均P<0.05)。ROC曲线显示,创伤发生后7 d的HMGB1水平预测不良预后的曲线下面积为0.890,敏感度为83.5%,特异度为92.3%。结论·多发伤患者创伤发生后不同时间点HMGB1及sTREM-1水平与MODS及生存结局相关,且创伤发生后7 d的HMGB1水平是多发伤患者不良结局的独立影响因素。

Objective·To detect the serum levels of high mobility group box 1(HMGB1)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)in patients with multiple injuries at different time points,and to analyze their correlation with disease severity,complications and prognosis.Methods·Ninety-two patients with multiple injuries admitted to the Department of Emergency Medicine of the Suzhou Ninth People's Hospital from December 2020 to December 2022 were selected.According to the injury severity scores of the patients at admission,the patients were divided into light injury group(n=24),grave injury group(n=58)and severe injury group(n=10).According to whether there was multiple organ dysfunction syndrome(MODS)after admission,the patients were divided into MODS group(n=20)and non-MODS group(n=72).According to the outcome within 28 d after trauma,the patients were divided into death group(n=13)and survival group(n=79).Inflammatory factor indicators in venous blood of patients after admission were detected.Enzyme linked immunosorbent assay(ELISA)was used to detect the serum HMGB1 and sTREM-1 levels at 24 h,72 h and 7 d after trauma,and the differences of serum HMGB1 and sTREM-1 levels among different groups were analyzed.Multiple Logistic regression was used to analyze the influencing factors of adverse outcomes in patients with multiple injuries.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of HMGB1 and sTREM-1 for adverse outcomes.Results·The levels of HMGB1 and sTREM-1 in the grave injury and severe injury groups were significantly higher than those in the light injury group(P<0.05).The levels of HMGB1 at 72 h and 7 d,and sTREM-1 at 24 h and 72 h in the severe injury group were significantly higher than those in the grave injury group(P<0.05).There was a positive correlation between HMGB1 and sTREM-1 levels at various time points(r=0.645,r=0.942,r=0.722;all P<0.05).The levels of HMGB1 at 72 h and 7 d,and sTREM-1 at 24 h and 72 h in the MODS group were significantly higher than those in the non-MODS group(all P<0.05).The levels of HMGB1 at 72 h and 7 d,and sTREM-1 at 24 h and 72 h in the death group were significantly higher than those in the survival group(all P<0.05).Logistic regression analysis showed that HMGB1 at 7 d,admission time and hypersensitive C-reactive protein(hs-CRP)were independent factors of adverse outcomes in patients with multiple injuries(all P<0.05).The ROC curve showed that the area under the curve of HMGB1 for predicting poor prognosis at 7 days after trauma was 0.890,the sensitivity was 83.5%,and the specificity was 92.3%.Conclusion·The levels of HMGB1 and sTREM-1 are correlated with MODS and survival outcomes in patients with multiple injuries at different time points after trauma,and HMGB1 at 7 d after trauma is an independent factor affecting adverse outcomes in patients with multiple injuries.