外周血中性粒细胞核因子κB活化水平联合白介素6水平测定对严重多发伤患者发生多器官功能障碍综合征的预测价值  

Predictive Value of Peripheral Blood Neutrophilic Leukocyte NF- κB Activation Status Combined With IL- 6 for MODS Among Patients With Severe Polytrauma

作　　者：曾杰[1] 陈宁波[1] 胡卫健[1] 

机构地区：[1]四川省人民医院急救中心外科,四川省成都市610072

出　　处：《中国全科医学》2015年第15期1753-1757,共5页Chinese General Practice

基　　金：四川省卫生厅资助课题(140088)

摘　　要：目的探讨联合检测外周血中性粒细胞核因子κB(NF-κB)活化水平及白介素(IL)-6水平对严重多发伤患者发生多器官功能障碍综合征(MODS)的预测价值。方法回顾性分析2012年6月—2014年6月入住四川省人民医院急诊外科符合纳入与排除标准的严重多发伤患者60例,分析其临床资料。将患者按照预后分为MODS组(22例)和非MODS组(38例)。比较两组患者入院时外周血中性粒细胞NF-κB活化水平、IL-6水平、创伤严重度评分(ISS)及急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。观察以上指标对预测MODS发生的受试者工作特征曲线(ROC曲线)下面积(AUC),并找出预测MODS的最佳截断值;比较联合检测外周血中性粒细胞NF-κB活化水平和IL-6水平、ISS得分及APACHEⅡ得分预测MODS发生的AUC值。结果MODS组患者ISS得分、APACHEⅡ得分、外周血NF-κB活化水平及IL-6水平均高于非MODS组(P<0.05)。Logistic回归分析结果显示,ISS得分、APACHEⅡ得分、外周血NF-κB活化水平及IL-6水平均不是严重多发伤患者发生MODS的影响因素(P>0.05)。ISS得分、APACHEⅡ得分、外周血中性粒细胞NF-κB活化水平及IL-6水平预测MODS发生的AUC分别为0.675〔95%CI=(0.542,0.791)〕、0.758〔95%CI=(0.630,0.859)〕、0.830〔95%CI=(0.710,0.914)〕及0.841〔95%CI=(0.724,0.923)〕。截断值:ISS得分>20分、APACHEⅡ得分>15分、外周血中性粒细胞NF-κB活化水平>1.17及IL-6水平>24.3μg/L时,灵敏度分别为:63.64%、68.18%、77.27%及85.45%,阳性似然比分别为2.20、2.59、3.34及2.13。外周血中性粒细胞NF-κB活化水平>1.17的严重多发伤患者MODS发生率为81.0%(17/21);IL-6水平>24.3μg/L的严重多发伤患者MODS发生率为57.1%(20/35);同时满足外周血中性粒细胞NF-κB活化水平>1.17及IL-6水平>24.3μg/L的严重多发伤患者MODS发生率为89.5%(17/19)。ISS得分>20分及APACHEⅡ得分>15分预测患者发生MODS的AUC分别为0.675〔95%CI=(0.542,0.791)〕及Objectjve To study the predictive value of peripheral blood neutrophilic leukocyte nuclear factor kappa B （NF - κB）activation status combined with IL - 6 for MODS among patients with severe polytrauma. Methods A total of 60 patients with severe polytrauma who were admitted to Surgical Department of Emergency Center in the People′s Hospital of Sichuannbsp;Province from June 2012 to June 2014,were selected as study subjects,all cases med inclusion and exclusion criteria,and their clinical data were retrospectively analyzed. Patients were divided into MODS group（22 cases）and non - MODS group（38 cases）according to prognosis,and the peripheral blood neutrophilic leukocyte NF - κB activation status,level of IL - 6,scores of injury severity scoring（ISS）and Acute Physiology and Chronic Health Evaluation（APACHE Ⅱ）were compared between two groups. The receiver operating characteristic curve （ ROC curve） was drawn and aera under the ROC curve（ AUC） was calculated to analyze the function of those risk factors in judging the MODS happening among severe polytrauma patients. The best cut - off values of those risk factors for MODS happening were searched. The AUC values according to different peripheral blood neutrophilic leukocyte NF - κB activation status combined with different IL - 6 levels,different scores of ISS and APACHE Ⅱwere compared. Results Levels of peripheral blood neutrophilic leukocyte NF - κB activation and IL - 6,and scores of ISS and APACHE Ⅱ among patients in MODS group were significantly higher than those among patients in non - MODS group（ P 〈0. 05）. According to multivariate Logistic regression analysis results,scores of ISS and APACHE Ⅱ,levels of peripheral blood neutrophilic leukocyte NF - κB activation and IL - 6 were not influence factors for the happening of MODS among patients with severe polytrauma（P 〉 0. 05）. The AUC values according to different peripheral blood neutrophilic leukocyte NF - κB activation status combined with different IL - 6

关 键 词：严重多发伤 多器官功能衰竭 全身炎症反应综合征 细胞因子 白介素6 

分 类 号：R59[医药卫生—内科学]