急性大出血患者血清CCL25和sTLT-1水平表达与输血相关性急性肺损伤发生的相关性研究

Study on the Correlation between the Level Expression of Serum CCL25 and sTLT-1 in Patients with Acute Massive Hemorrhage and the Occurrence of Transfusion Related Acute Lung Injury

目的探讨急性大出血患者血清趋化因子C-C基元配体25(CC motif chemokine ligand 25,CCL25),可溶性髓样细胞触发受体样转录因子-1(soluble trem-like transcript-1,sTLT-1)水平表达与输血相关性急性肺损伤(transfusion-related acute lung injury,TRALI)发生的相关性。方法选取巴中市中心医院2021年8月~2023年7月期间收治的126例急性大出血患者为研究对象,根据Murray肺损伤评分判断患者在输血过程中是否发生TRALI,将发生TRALI患者设置为研究组(n=32),未发生TRALI患者设置为对照组(n=94)。比较两组患者一般临床病理资料;采用酶联免疫吸附测定法(ELISA)检测两组患者输血前和输血6 h后血清CCL25和sTLT-1水平;Spearman法分析血清CCL25,sTLT-1与Murray肺损伤评分的相关性;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析CCL25和sTLT-1水平对急性大出血患者发生TRALI的预测价值。结果研究组患者输血6 h后血清CCL25(15.33±2.06 ng/ml),sTLT-1(580.19±55.62 pg/ml)水平高于输血前(12.86±1.24 ng/ml,486.33±49.25 pg/ml)和对照组(12.57±1.35 ng/ml,474.47±55.42 pg/ml),差异具有统计学意义(t=5.811,8.477;5.634,8.339,均P<0.05);对照组输血6h后CCL25,sTLT-1水平表达与输血前(12.852.18ng/ml,489.63±52.18 pg/ml)比较,差异无统计学意义(t=1.059,1.931,P>0.05)。研究组输血6h后血清CCL25和sTLT-1水平与Murray肺损伤评分均呈正相关(r=0.735,0.625,均P<0.05)。血清CCL25和sTLT-1预测急性大出血患者发生TRALI的AUC分别为0.810和0.877,截断值分别为14.609 ng/ml和512.583 pg/ml,二者联合预测的AUC为0.949,对急性大出血患者发生TRALI具有更高的预测价值(Z=0.139,0.072,均P<0.05)。结论CCL25和sTLT-1在急性大出血且发生TRALI患者血清中表达量上升,二者与Murray肺损伤评分之间具有相关性,血清CCL25,sTLT-1联合诊断对急性大出血患者发生TRALI具有预测价值。

Objective To investigate the correlation between the level expression of serum CC motif chemokine ligand 25(CCL25)and soluble trem-like transcript-1(sTLT-1)in patients with acute massive hemorrhage and the occurrence of transfusionrelated acute lung injury(TRALI).Methods A total of 126 patients with acute massive bleeding admitted to Bazhong Central Hospital from August 2021 to July 2023 were selected as the study subjects.The Murray lung injury score was used to determine whether the patients had TRALI during the blood transfusion process.Patients with TRALI were assigned to the study group(n=32),while those without TRALI were assigned to the control group(n=94).The general clinical and pathological data of patients in the two groups were compared.Enzyme-linked immunosorbent assay(ELISA)was applied to detect the levels of serum CCL25 and sTLT-1 of patients in two groups before and after 6 hours of blood transfusion.Spearman method was applied to analyze the correlation between serum CCL25,sTLT-1,and Murray lung injury score.The predictive value of CCL25 and sTLT-1 for TRALI in patients with acute massive hemorrhage was analyzed using the receiver operating characteristic(ROC)curve.Results The levels of serum CCL25(15.33±2.06 ng/ml)and sTLT-1(580.19±55.62 pg/ml)in the study group after 6 hours of blood transfusion were higher than before blood transfusion(12.86±1.24 ng/ml,486.33±49.25 pg/ml)and control group(12.57±1.35 ng/ml,474.47±55.42 pg/ml),and the differences were statistically significant(t=5.811,8.477;5.634,8.339,all P<0.05).There was no statistically significant difference between the CCL25(12.85±2.18ng/ml)and sTLT-1(489.63±52.18 pg/ml)expression levels in the control group patients after 6 hours of blood transfusion and before transfusion(t=1.059,1.931,all P>0.05).The levels of serum CCL25 and sTLT-1 after 6 hours of transfusion in the study group were positively correlated with Murray lung injury score(r=0.735,0.625,all P<0.05).The AUCs of serum CCL25 and sTLT-1 for predicting the occurrence of TRALI in patients with acute massive hemorrhage were 0.810 and 0.877,respectively,with cutoff values of 14.609 ng/ml and 512.583 pg/ml.The AUC of combined prediction of CCL25 and sTLT-1 was 0.949,indicating a higher predictive value for TRALI in patients with acute massive hemorrhage(Z=0.139,0.072,all P<0.05).Conclusion The expression levels of CCL25 and sTLT-1 in the serum of patients with acute massive hemorrhage complicating TRALI were increased,and there was a correlation between the two and Murray lung injury score.The combined diagnosis of serum CCL25 and sTLT-1 has predictive value for the occurrence of TRALI in patients with acute massive hemorrhage.