肺挫伤患者早期外周血细胞因子水平的改变及临床意义  

The value of plasma cytokines in prediction of prognosis for patients with pulmonary contusion

作　　者：殷娟[1] 张明红[2] 

机构地区：[1]攀枝花市中心医院检验科,四川攀枝花617067 [2]攀枝花市仁和区人民医院检验科

出　　处：《中国实验诊断学》2017年第3期435-437,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的检测肺挫伤患者早期外周血细胞因子水平,并分析其对伤后并发急性呼吸窘迫综合征(ARDS)的预测诊断价值,以期为临床诊疗提供参考。方法分析2013年1月至2016年1月在我院ICU接受诊疗的因胸外伤所致肺挫伤患者的临床资料。依据伤后1周内是否发生ARDS将患者分为观察组(ARDS)及对照组(非ARDS)。检测对比两组外周血细胞/炎症因子水平。结果共纳入观察组45例,对照组43例。两组患者外周血IL-10水平比较无显著性差异(P>0.05)。观察组患者外周血CRP、TNF-α及DD水平均显著高于对照组患者(P<0.05)。相关性分析显示,观察组患者外周血CRP、TNF-α及DD水平呈现两两显著正相关关系(P<0.05)。ROC曲线分析显示,以20.93ng/L为截点值,TNF-α预测肺挫伤后并发ARDS的敏感性为86.67%,特异性为81.40%,曲线下面积为0.90,优于CRP及DD。结论肺挫伤后外周血炎症因子及DD水平显著升高,这些指标对预测ARDS的发生具有一定预测价值,其中TNF-α诊断价值最佳。Objective Our study was aimed toanalyze the predictive value of plasma cytokines in prediction of prognosis for patients with pulmonary contusion.Methods Clinical data of patients with pulmonary contusion received treatment at our hospital ICU from 2013 to 2016were analyzed.Patients were divided into two groups by whether suffer from ARDS,Group A：ARDS;group B：no ARDS.Results A total of 88 patients were analyzed,Group A 45 cases,Group B 43 cases.There was no statistical significance in serum IL-10 between the two groups（P〉0.05）.Group A patients had higher levels of CRP,TNF-αand DD than these of Group B patients,the difference were statistically significant（P〈0.05）.Correlation analysis showed that,for Group A patients,there are strong positive relations between CRP,TNF-αand DD（P〈0.05）.ROC analysis showed that theTNF-αcut-off point value of 20.93ng/L,as used for the prediction of ARDS 1week after pulmonary contusion,provided a sensitivity of 86.67%,a specificity of 81.40%,an AUC of 0.90,better than these of CRP and DD.Conclusion TNF-αcan be used as a predictive index of ARDS after pulmonary contusion.

关 键 词：肺挫伤 急性呼吸窘迫综合征 炎症 凝血功能 预后 

分 类 号：R563[医药卫生—呼吸系统]