外周血CD44、TNF-α和IL-6在胸部钝性创伤所致肺挫伤的表达水平及其临床意义  

Expression and clinical significance of CD44,TNF-αand IL-6 in peripheral blood of patients with pulmonary contusion caused by blunt chest trauma

作　　者：张盼盼[1] 易军[1] 董家寿[1] 柳雅奎 李奎 ZHANG Pan-pan;YI Jun;DONG Jia-shou;LIU Ya-kui;LI Kui(Extrathoracic and Cardiovascular Surgery,Jingmen First People s Hospital,Jingmen 448000,Hubei,China)

机构地区：[1]荆门市第一人民医院胸外、心脏大血管外科,湖北荆门448000

出　　处：《川北医学院学报》2021年第3期333-336,共4页Journal of North Sichuan Medical College

基　　金：湖北省荆门市科学技术研究与开发计划(2019YFZD022)。

摘　　要：目的:探讨外周血CD44、TNF-α和IL-6在胸部钝性创伤所致肺挫伤患者的表达水平及临床意义。方法:酶联免疫吸附试验(ELISA)检测外周血CD44、TNF-α、IL-6水平在胸部钝性创伤所致肺挫伤患者(病例组,n=45)和同期健康人群(对照组,n=45)的表达水平。分析CD44、TNF-α和IL-6与病例组肺挫伤严重(轻度、中度、高度)及继发急性呼吸窘迫综合征(ARDS)的差异,并通过Logistic回归分析肺挫伤后继发ARDS的危险因素,绘制ROC曲线评价外周血CD44、TNF-α、IL-6及三者联合对肺挫伤后继发ARDS的预测价值。结果:病例组外周血CD44、TNF-α和IL-6的表达水平均高于对照组(P<0.05);且CD44、TNF-α和IL-6的表达水平在轻度组、中度组、重度组肺挫伤中呈依次上升趋势(P<0.05);CD44、TNF-α和IL-6表达水平在肺挫伤继发ARDS高于非ARDS(P<0.05)。Logistic回归分析显示年龄、血小板计数、合并糖尿病、合并多发伤及外周血CD44、TNF-α、IL-6表达水平是肺挫伤后继发ARDS的危险因素(P<0.05);当CD44>3.17 ng/mL时预测肺挫伤后继发ARDS的敏感度为57.1%,特异性为94.7%;当TNF-α>26.31ng/L时,敏感度为71.4%,特异性为73.7%;当IL-6>41.25ng/L时,敏感度为71.4%,特异性为92.1%;三者联合的敏感度为85.7%,特异性为89.4%。结论:胸部钝性创伤所致肺挫伤患者外周血CD44、TNF-α和IL-6表达水平明显上升,且与肺挫伤严重程度和继发ARDS相关,三者联合可作为预测继发ARDS的辅助指标。Objective:To investigate the expression and clinical significance of CD44,TNF-α,and IL-6 in peripheral blood of patients with pulmonary contusion caused by blunt chest trauma.Methods:Enzyme linked immunosorbent assay(ELISA)was used to detect the expression of CD44,TNF-αand IL-6 in peripheral blood of patients with pulmonary contusion caused by blunt chest trauma(case group,n=45)and healthy people(control group,n=45).The differences of CD44,TNF-αand IL-6 with severe pulmonary contusion(mild,moderate and high)and secondary acute respiratory distress syndrome(ARDS)were also analyzed.Logistic regression was used to analyze the risk factors of ARDS secondary to pulmonary contusion,and ROC curve was drawn to evaluate the predictive value of peripheral blood CD44,TNF-α,IL-6 and their combination on ARDS secondary to pulmonary contusion.Results:The expression levels of CD44,TNF-αand IL-6 in peripheral blood in the case group was significantly higher than that in the control group(P<0.05),and that in the mild group,moderate group and severe group increased in turn(P<0.05).The expression levels of CD44,TNF-αand IL-6 in the ARDS group was obviously higher than that in the non-ARDS group(P<0.05).Logistic regression analysis showed that age,platelet count,diabetes mellitus,multiple trauma and the expression of CD44,TNF-αand IL-6 in peripheral blood were the independent influencing factors of ARDS after pulmonary contusion(P<0.05).When CD44>3.17 ng/mL,the sensitivity and specificity respectively were 57.1%and 94.7%.When TNF-α>26.31 ng/L,the sensitivity and specificity were 71.4%and 73.7%,respectively.When IL-6>41.25 ng/L,the sensitivity and specificity were 71.4%and 92.1%,the sensitivity and specificity of the combination of the three were 85.7%and 89.4%.Conclusion:The expression levels of CD44,TNF-αand IL-6 in peripheral blood of patients with pulmonary contusion caused by blunt chest trauma increased,which are related to the severity of pulmonary contusion and secondary ARDS.The combination of the three may be used

关 键 词：肺挫伤 钝性创伤 CD44 肿瘤坏死因子-α 白细胞介素-6 急性呼吸窘迫综合征 

分 类 号：R563[医药卫生—呼吸系统] R655[医药卫生—内科学]