血清KL-6在输血相关性急性肺损伤中应用价值研究  

The Role of Serum Kerbs Von Lungren 6 Antigen(KL-6) in Transfusion-related Acute Lung Injury

作　　者：王贵强[1] 林新梅[2] 冯均建[1] 张莉[1] 卫茂华[1] WANG Guiqiang;LIN Xin-mei;FENG Jun-jian(Department of Critical Care Medicine and Department of Blood Transfusion,Luzhou People's Hospital,Luzhou 646000)

机构地区：[1]四川省泸州市人民医院重症医学科,646000 [2]四川省泸州市人民医院输血科,646000

出　　处：《临床输血与检验》2019年第5期449-453,457,共6页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：四川省卫生和计划生育委员会科研项目（NO.16PJ168）;泸州市科学技术和知识产权局科技计划项目[NO.2016-S-60（3/3）]资助

摘　　要：目的研究血清KL-6在输血相关性急性肺损伤(TRALI)中的诊断价值和病情严重程度的预测价值。方法气管插管机械通气并行输血治疗的患者分别在输血前、输血后6h、若发生TRALI在临床诊断TRALI时均进行血浆B型利钠肽(BNP)水平测定、动脉血气分析、床旁胸部X线检查、监测呼吸机参数、进行Murray肺损伤评分、采用ELISA法检测血清KL-6水平;按照TRALI的诊断标准分为TRALI组和非TRALI组,比较TRALI组(16例)和非TRALI组(79例)输血前后各观察指标的差异性;分析血清KL-6与Murray肺损伤评分、氧合指数的相关性;采用受试者工作特征曲线(ROC)评价血清KL-6在TRALI中的诊断价值。结果输血前,TRALI组和非TRALI组在Murray肺损伤评分、平台压(Pplat)、峰压(Ppeak)、氧合指数、血清KL-6水平、血浆BNP水平方面的差异均无统计学意义,均P>0.05;输血后6h,TRALI组的血清KL-6水平、Murray肺损伤评分、Ppeak和Ppat均明显高于非TRALI组,氧合指数明显低于非TRALI组,差异均有统计学意义,P<0.05;血清KL-6水平与Murray肺损伤评分成正相关(r=0.811,P<0.001),与氧合指数呈负相关(r=–0.680,P<0.001);ROC曲线分析显示,血清KL-6水平在预测TRALI方面有显著意义,其曲线下面积(AUC)为0.960,P<0.001。当血清KL-6水平大于369U·mL^-1时,预测TRALI的敏感度为85.0%,特异性为97.4%。结论血清KL-6作为急性肺损伤的血清学标志物,在机械通气患者输血治疗过程中有助于TRALI的实验室诊断和病情严重程度评估。Objective To explore the value of serum Kerbs von den Lungren 6(KL-6)in diagnosis of transfusionrelated acute lung injury(TRALI).Methods Before transfusion,at the time of 6h after that in 95 patients with mechanical ventilation,at the time of clinical diagnosis of TRALI when TRALI occurred,the observations including such as plasma BNP levels,arterial blood gas analysis,bedside chest X-ray examination,ventilator parameters,Murray lung injury score,serum KL-6 levels detected by ELISA method were collected.95 patients with mechanical ventilation were divided into TRALI group and non-TRALI group according to the criteria of transfusion-related acute lung injury.Compared to before transfusion,the changes of serum KL-6 levels were analyzed between the TRALI group and non-TRALI group.The relationship between serum KL-6 and Murray lung injury score,oxygenation index was analyzed.In addition,the diagnostic significance of serum KL-6 was evaluated using ROC curve for diagnosing TRALI.Results Before transfusion,there were no statistically significant differences in Murray lung injury score,plat pressure(Pplat),peak pressure(Ppeak),oxygenation index,serum KL-6 levels,and BNP levels between the TRALI group and the non-TRALI group,P>0.0 5.In non-TRALI group,serum KL-6,BNP,lung injury score,oxygenation index,Ppeak and Pplat before transfusion were not significantly different than that at the time of 6h after transfusion,P>0.05.In TRALI group,compared to before transfusion,serum KL-6 levels were significantly higher,Murray lung injury score were significantly higher,Ppeak and Pplat were significantly higher,oxygenation index is significantly lower,at the time of clinical diagnosis of TRALI and at the time of 6h after transfusion,P<0.05.Compared with non-TRALI group,at the time 6h after transfusion,Serum KL-6 levels was significantly higher,lung injury score was significantly higher,oxygen combination index was significantly lower,Ppeak and Ppat were significantly higher in TRALI group,P<0.0 5.Serum KL-6 level was positively corr

关 键 词：涎液化糖链抗原6 输血相关性急性肺损伤 诊断 评估 

分 类 号：R563[医药卫生—呼吸系统]