生物标志物联合创伤评分对创伤后脓毒症的诊断价值  

The diagnostic value of biomarkers combined with injury severity score in post-traumatic sepsis

作　　者：阿米娜·阿不列孜 阿合买提江·帕哈丁[1] 黄扬眉 朱功兵[1] Amina Abuliezi;Ahemaitijiang Pahading;Huang Yangmei;Zhu Gongbing(Department of Emergency Trauma Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China;Emergency Medical Center of Chongqing,Chongqing 400014,China)

机构地区：[1]新疆医科大学第一附属医院急救创伤中心,乌鲁木齐830000 [2]重庆市急救医疗中心,重庆400014

出　　处：《创伤外科杂志》2021年第5期384-390,共7页Journal of Traumatic Surgery

摘　　要：目的探讨各生物标志物联合创伤评分对创伤后脓毒症诊断及预后的预测价值,生物标志物联合评分的新型组合诊断创伤后脓毒症的诊断效能。方法前瞻性研究2019年12月—2020年6月新疆医科大学第一附属医院急救创伤中心收治严重创伤患者196例,男性129例,女性67例;年龄20~94岁,平均49.7岁。于入院后24h内抽取外周血标本并检测T细胞亚群项目,主要包括CD4、CD8、CD4/CD8;降钙素原(PCT)、白介素-6(IL-6)、乳酸、中性粒细胞、淋巴细胞等生物标志物,同时收集损伤重度评分(ISS)等。根据脓毒症诊断标准将患者分为脓毒症组(61例)和非脓毒症组(135例),再根据预后结果将脓毒症组患者分为死亡组(26例)和存活组(35例)。用Logistic回归分析确定诊断创伤后脓毒症及预后相关影响因素,绘制ROC曲线,比较各生物标志物及联合评分的新型组合及单独使用时对创伤后脓毒症的诊断效能。结果脓毒症组与非脓毒症组以及死亡组与存活组中,CD4、CD8、CD4/CD8、PCT、IL-6、乳酸、ISS比较差异均有统计学意义(P<0.05)。Logistic回归单因素分析显示CD4、CD8、CD4/CD8、PCT、IL-6、乳酸、ISS等均与创伤后脓毒症有关(P<0.05)。其中CD4/CD8及ISS评分是诊断创伤后脓毒症独立影响因素(P<0.01)。从创伤后脓毒症发病机制不同方面选取PCT、ISS及CD4/CD8形成新的组合,检测其联合诊断的效能,ROC曲线下面积AUC为0.927,95%CI为0.881~0.959;高于PCT,ISS和CD4/CD8单独使用的AUC(分别为0.840、0.866、0.847);95%CI为0.781~0.888、0.881~0.911、0.789~0.894。标志物及联合评分组合的灵敏度、特异度,阴性预测值,阳性预测值也均较单独使用时得到提高(联合评分组合诊断分别为91.80%、81.48%、94.78%、67.90%;PCT分别为72.13%、81.48%、85.83%、62.32%;CD4/CD8分别为65.57%、87.41%、84.29%、69.64%;ISS分别为77.05%、80.74%、88.52%、63.51%)。ISS为创伤后脓毒症死亡的独立危险因素(P<0.05),9Objective To explore the diagnostic and prognostic value of biomarkers and the injury severity score(ISS)in post-traumatic sepsis patients,and to determine the diagnostic efficacy of a novel combination of biomarkers and scoring.Methods A total of 196 patients with severe trauma were enrolled in this prospective study at the Department of Emergency Trauma Center of The First Affiliated Hospital of Xinjiang Medical University between Dec.2019 and Jun.2020.There were 129 males and 67 females,with a mean age of 49.7 years(range,20-94 years).Blood was drawn within the first 24h hours of admission,and the levels of T lymphocyte subsets were tested,including CD4,CD8,CD4/CD8.Biomarkers such as procalcitonin(PCT),interleukin-6(IL-6),lactate,neutrophils,lymphocytes were detected.Meanwhile,ISS score was collected.Patients were divided into the sepsis group(61 cases)and non-sepsis group(135 cases)according to the diagnostic criteria of sepsis.The patients in the sepsis group were then divided into the non-survival group(26 cases)and survival group(35 cases)according to the prognosis.Logistic regression analysis was used to determine the diagnostic and prognostic influencing factors of post-traumatic sepsis,receiver operating characteristic(ROC)curve was performed to compare the diagnostic ability of each biomarker and scoring alone and in combination in post-traumatic sepsis.Results There were statistically significant differences in CD4,CD8,CD4/CD8,PCT,IL-6,lactate and ISS between the sepsis and non-sepsis groups,and between the non-survival and survival groups(P<0.05).Logistic regression univariate analysis showed that CD4,CD8,CD4/CD8,PCT,IL-6,lactic acid,and ISS were all related to post-traumatic sepsis(P<0.05 or P<0.01).Among them,CD4/CD8 and ISS were the independent influencing factors in the diagnosis of post-traumatic sepsis(P<0.01).PCT,ISS and CD4/CD8 were selected from different aspects of the pathogenesis of post-traumatic sepsis to form a new combination and the efficacy of their combined diagnosis were tested.Th

关 键 词：创伤后脓毒症 生物标志物 创伤评分 诊断价值 

分 类 号：R459.7[医药卫生—急诊医学]