血清PCT、IL-6及MIP-2水平评估重型颅脑损伤气管切开术后并发肺部感染的价值

Value of serum levels of PCT,IL-6 and MIP-2 in assessing secondary pulmonary infection in patients with severe traumatic injury after tracheotomy

目的探讨血清降钙素原(PCT)、白细胞介素-6(IL-6)及巨噬细胞炎性蛋白-2(MIP-2)水平评估重型颅脑损伤气管切开术后并发肺部感染的价值。方法2020年5月至2021年10月前瞻性收集145例重型颅脑损伤病人,入院当天行气管切开术,气管切开术前及术后1、3、5 d检测血清PCT、IL-6、MIP-2水平,记录入院1周内肺部感染情况。结果入院1周,86例确诊肺部感染,肺部感染发生率为59.31%(86/145)。肺部病人气管切开术后3、5 d血清PCT、IL-6、MIP-2水平明显增高(P<0.05)。ROC曲线分析显示,气管切开术后3 d血清PCT、IL-6及MIP-2水平增高评估肺部感染的曲线下面积(AUC)为0.907(95%CI 0.848~0.949),灵敏度为96.51%,特异度为76.27%,准确度为88.28%;气管切开术后5 d血清PCT、IL-6及MIP-2水平增高评估肺部感染的AUC为0.898(95%CI 0.837~0.942),灵敏度为94.19%,特异度为74.58%,准确度为86.21%。气管切开术后3、5 d血清PCT、IL-6及MIP-2水平增高评估肺部感染与临床诊断结果一致性的Kappa值分别为0.750、0.706。结论重型颅脑损伤气管切开术后发生肺部感染时血清PCT、IL-6、MIP-2水平明显升高,因此,术后监测血清PCT、IL-6、MIP-2水平有助于临床早期诊断肺部感染。

Objective To explore the value of serum levels of procalcitonin(PCT),interleukin-6(IL-6),and macrophage inflammatory protein-2(MIP-2)in assessing pulmonary infection in patients with severe traumatic injury(sTBI)after tracheotomy.Methods One hundren and fifty-five patients with sTBI were prospectively collected From May 2020 to October 2021.Tracheotomy was performed on the day of admission.Serum PCT,IL-6,and MIP-2 levels were detected before tracheotomy and on days 1,3,and 5 after tracheotomy,and the pulmonary infection within 1 week of admission was recorded.Results Within 1 week of admission,86 patients were diagnosed with pulmonary infection,and the incidence of pulmonary infection was 59.31%(86/145).The levels of serum PCT,IL6,and MIP-2 in patients with pulmonary infection significantly increased on days 3 and 5 after tracheotomy(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for assessing pulmonary infection using the increased levels of serum PCT,IL-6,and MIP-2 on day 3 after tracheotomy was 0.907(95%CI 0.848~0.949),with a sensitivity of 96.51%,specificity of 76.27%,and accuracy of 88.28%;the AUC for assessing pulmonary infection using the increased levels of serum PCT,IL-6,and MIP-2 on day 5 after tracheotomy was 0.898(95%CI 0.837~0.942),with a sensitivity of 94.19%,specificity of 74.58%,and accuracy of 86.21%.The Kappa values for the consistency between the assessment of pulmonary infection using the increased levels of serum PCT,IL-6,and MIP-2 on days 3 and 5 after tracheotomy and the clinical diagnosis results were 0.750 and 0.706,respectively.Conclusion When pulmonary infection occurs after tracheotomy in patients with sTBI,the levels of serum PCT,IL-6,and MIP-2 increase significantly.Therefore,monitoring the levels of serum PCT,IL-6,and MIP-2 is helpful for the early clinical diagnosis of pulmonary infection in patients with sTBI after the tracheotomy.