进行气管插管的颅脑外伤患者血清GM-CSF和HMGB1水平及其与并发肺部感染的关系

Relationship between serum GM-CSF and HMGB1 levels with complicating pulmonary infection in patients with traumatic brain injury undergoing tracheal intubation

目的探讨血清粒-巨噬细胞集落刺激因子(GM-CSF)、高迁移率族蛋白B1(HMGB1)与进行气管插管的颅脑外伤患者并发肺部感染的关系。方法选取2020年12月至2022年12月华北医疗健康集团峰峰总医院收治的156例进行气管插管的颅脑外伤患者作为颅脑外伤组,根据是否出现肺部感染将进行气管插管的颅脑外伤患者分为感染组和未感染组,另根据临床肺部感染评分(CPIS)将进行气管插管的颅脑外伤并发肺部感染患者分为重度感染组和轻度感染组,并选取同期在华北医疗健康集团峰峰总医院体检的体检健康者60例作为对照组。采用酶联免疫吸附试验(ELISA)测定所有研究对象血清GM-CSF、HMGB1水平;分析进行气管插管的颅脑外伤并发肺部感染患者血清GM-CSF、HMGB1水平与CPIS的关系;采用多因素Logistic回归分析进行气管插管的颅脑外伤患者并发肺部感染的影响因素;采用受试者工作特征(ROC)曲线分析血清GM-CSF、HMGB1对进行气管插管的颅脑外伤患者并发肺部感染的预测价值。结果与对照组相比,颅脑外伤组患者血清GM-CSF、HMGB1水平均明显升高(P<0.05)。感染组患者血清GM-CSF、HMGB1水平显著高于未感染组(P<0.05)。重度感染组21例,轻度感染组45例。与轻度感染组患者相比,重度感染组患者血清GM-CSF、HMGB1水平及CPIS均显著升高(P<0.05)。相关分析结果显示,感染组患者血清GM-CSF、HMGB1水平与CPIS均呈正相关(r=0.408、0.435,P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、入院时GCS评分≥6分、合并糖尿病、GM-CSF水平升高、HMGB1水平升高均是进行气管插管的颅脑外伤患者并发肺部感染的危险因素(P<0.05)。ROC曲线分析结果显示,GM-CSF、HMGB1联合预测进行气管插管的颅脑外伤患者并发肺部感染的曲线下面积(AUC)为0.912(95%CI:0.860~0.963),明显大于GM-CSF、HMGB1单项预测的AUC[0.826(95%CI:0.756~0.895)、0.819(95%CI:0.743~0.896)],差异均有统计学意义(Z=1.972,P=0.049;Z=1.984,P=0.047)。结论血清GM-CSF、HMGB1水平在进行气管插管的颅脑外伤并发肺部感染的患者中升高,是进行气管插管的颅脑外伤患者发生肺部感染的危险因素,2项指标联合检测对进行气管插管的颅脑外伤患者并发肺部感染具有良好的预测价值。

Objective To investigate the relationship between serum granulocyte macrophage colony-stimulating factor(GM-CSF)and high mobility group protein B1(HMGB1)with pulmonary infection in the patients with traumatic brain injury undergoing tracheal intubation.Methods A total of 156 patients with traumatic brain injury undergoing tracheal intubation were admitted and treated in Fengfeng General Hospital of North China Medical and Health Group from December 2020 to December 2022 were selected as the traumatic brain injury group.The patients with traumatic brain injury complicated with pulmonary infection undergoing tracheal intubation were divided into the infection group and non-infection group according to whether or not appearing pulmonary infection.In addition,the patients with traumatic brain injury undergoing tracheal intubation complicating pulmonary infection were divided into the severe infection group and mild infection group according to the Clinical Pulmonary Infection Score(CPIS).Sixty healthy individuals undergoing the physical examinations at this hospital during the same period were selected as the control group.The enzyme linked immunosorbent assay(ELISA)was used to measure the serum GM-CSF and HMGB1 levels in all study subjects.The relationship between serum GM-CSF and HMGB1 levels with the CPIS in the patients with undergoing traumatic brain injury complicating pulmonary infection was analyzed;the multiple Logistic regression was adopted to analyze the influencing factors of complicating pulmonary infection in the patients with traumatic brain injury undergoing tracheal intubation;the receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum GM-CSF and HMGB1 for complicating pulmonary infection in the patients with traumatic brain injury undergoing tracheal intubation.Results Compared with the control group,the serum GM-CSF and HMGB1 levels in the traumatic brain injury group were significantly increased(P<0.05).The serum GM-CSF and HMGB1 levels in the infection group were significantly higher than those in the non-infection group(P<0.05).There were 21 cases in the severe infection group and 45 cases in the mild infection group.Compared with the patients in the mild infection group,the serum GM-CSF,HMGB1 and CPIS in the patients of the severe infection group were significantly increased(P<0.05).The correlation analysis results showed that the serum GM-CSF and HMGB1 levels in the infection group were positively correlated with the CPIS(r=0.408,0.435,P<0.05).The multivariate Logistic regression analysis showed that the age≥60 years old,GCS score≥6 points at admission,complicating diabetes,GM-CSF level increase and HMGB1 level increase all were the risk factors for pulmonary infection occurrence in the traumatic brain injury patients undergoing tracheal intubation(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of GM-CSF and HMGB1 combined detection for prediction complication pulmonary infection in the patients with tramatic brain injury undergoing tracheal intubation was 0.912(95%CI:0.860-0.963),which was significantly greater than AUC of GM-CSF and HMGB1 single detection[0.826(95%CI:0.756-0.895),0.819(95%CI:0.743-0.896)],and the differences were statistically significant(Z=1.972,P=0.049;Z=1.984,P=0.047).Conclusion The levels of serum GM-CSF and HMGB1 are elevated in the patients with traumatic brain injury undergoing tracheal intubation complicating pulmonary infection,which are the risk factors for pulmonary infection occurrence in the patients with traumatic brain injury undergoing tracheal intubation.The combined detection of these two indicators has good predictive value for complicating pulmonary infection in the patients with traumatic brain injury undergoing tracheal intubation.