大量输血前后血清涎液化糖链抗原-6的变化及其临床价值  

The application value of serum Kerbs Von den Lungren-6 antigen(KL-6)in 42 cases of massive transfusion

作　　者：王贵强[1] 林新梅[2] 杨盛泉[1] 冯均建[1] 雷贤英 卫茂华[2] 陈萍[2] 章庆[4] WANG Guiqiang;LIN Xinmei;YANG Shengquan;FENG Junjian;LEI Xianying;WEI Maohua;CHEN Ping;ZHANG Qing(Department of Critical Care Medicine,Luzhou People′s Hospital,Luzhou 646000,China)

机构地区：[1]泸州市人民医院重症医学科,四川泸州646000 [2]泸州市人民医院输血科,四川泸州646000 [3]西南医科大学附属医院ICU,四川泸州646000 [4]泸州市人民医院麻醉科,四川泸州646000

出　　处：《实用医学杂志》2019年第6期888-892,897,共6页The Journal of Practical Medicine

基　　金：四川省卫生和计划生育委员会科研项目(编号:16PJ168);泸州市科学技术和知识产权局科技计划项目[编号:2016-S-60(3/3)]

摘　　要：目的探讨血清涎液化糖链抗原-6(KL-6)在大量输血患者中对输血相关性急性肺损伤(TRALI)的诊断、病情评估价值和对临床选择合适的血制品输注的指导价值。方法 42例大量输血患者在输血前、输血完毕6 h均进行血浆B型利钠肽(BNP)测定、动脉血气分析、床旁胸部X检查、Murray肺损伤评分、采用酶联免疫吸附反应法(ELISA)检测血清KL-6水平,记录血制品输注的种类与数量;根据是否发生TRALI分为TRALI组和非TRALI组,比较血清KL-6在大量输血前后的变化,分析血清KL-6与氧合指数、Murray肺损伤评分和不同血液制品输注量的相关性。结果与输血前比较,TRALI组在大量输血后6 h氧合指数更低,血清KL-6水平、Murray肺损伤评分更高,差异均有统计学意义(均P <0.01);非TRALI组输血前后氧合指数、Murray肺损伤评分、KL-6水平及BNP水平的差异均无统计学意义(均P> 0.05);大量输血后6 h,TRALI组血清KL-6水平明显高于非TRALI组(P <0.01);血清KL-6水平与氧合指数呈负相关(r=-0.648,P <0.01),与Murray肺损伤评分呈正相关(r=0.895,P <0.01);与非TRALI组比较,TRALI组新鲜冰冻血浆(FFP)的输注量、库存大于1周红细胞悬液的输注量更多,去白红细胞输注量更少,差异均有统计学意义(均P <0.01);大量输血后6 h血清KL-6水平与FFP输注量、库存大于1周红细胞悬液输注量均呈正相关(r=0.654,P <0.01;r=0.741,P <0.01)、与去白红细胞输注量呈负相关(r=-0.826,P <0.01)。结论血清KL-6在大量输血患者中有助于TRALI诊断和严重程度评估,对血液制品种类的合理选择具有临床指导意义。Objective To investigate the change of serum KL-6 level after blood transfusion in patients with massive transfusion,to explore the diagnostic and prognostic value of serum KL-6 in TRALI,and to assess the clinical guiding role of serum KL-6 for the reasonable blood product infusion. Methods Before transfusion,at the time of 6 h after blood transfusion in 42 patients with massive transfusion,the observation targets such as plasma BNP levels,arterial blood gas analysis,bedside chest X-ray examination,Murray lung injury score,serum KL-6 levels detected by ELISA method were collected. The type of blood products and the amount of blood transfu- sion were recorded. Forty-two patients with massive transfusion were divided into TRALI group and non-TRALI group according to the criteria of transfusion-related acute lung injury. Compared to those before transfusion,the changes of those observation parameters were analyzed after massive transfusion. The relationships between serum KL-6 level and Murray lung injury score,oxygenation index,the infusion amount of different blood products were analyzed. Results Compared to that before transfusion,at the time of 6 h after massive transfusion in TRALI group,the oxygenation index was significantly lowered,the serum KL-6 level and Murray lung injury score were significantly elavated(P < 0.01,respectively). There were no statistically significant differences in oxygenation index,Murray lung injury score,KL-6 level and BNP level before and after transfusion in the non-TRALI group (P > 0.05,respectively). Serum KL-6 level was negatively correlated with the oxygenation index(r =-0.648,P < 0.01),and positively correlated with Murray lung injury score(r = 0.895,P < 0.01). Results of subgroup analysis showed that the serum KL-6 level at the time of 6h after massive transfusion in TRALI group was significantly higher than that in the non-TRALI group(P < 0.01). The infusion volume of fresh frozen blood plasma and the infusion volume of red blood cells suspension older than 1 week in TRALI we

关 键 词：大量输血 涎液化糖链抗原-6 输血相关性急性肺损伤 应用价值 

分 类 号：R457.1[医药卫生—治疗学]