外周血SP-D、SP-A、IL-1β对创伤性肠破裂患者术后急性肺损伤的预测及病情评估价值  

Value of peripheral blood SP-D,SP-A and IL-1βin prediction and severity evaluation of acute lung injury in traumatic enterorrhexis patients after surgery

作　　者：王琪 高明[1] 葛魏巍[1] 孙远松 WANG Qi;GAO Ming;GEWeiwei;SUN Yuansong(Department of Emergency Surgery,the Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院急诊外科,安徽合肥230601

出　　处：《中国普通外科杂志》2021年第10期1203-1211,共9页China Journal of General Surgery

基　　金：安徽医科大学校科学研究基金资助项目(2020xkj192)。

摘　　要：背景与目的:创伤性肠破裂(TE)患者术后常可能伴发急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS),危及生命,因此,选择合适的早期预测及病情严重程度评估指标具有重要意义。本研究探讨外周血肺表面活性蛋白D(SP-D)、肺表面活性蛋白A(SP-A)、白细胞介素1β(IL-1β)动态监测对TE术后伴发ALI/ARDS的早期预测及病情评估价值。方法:回顾性分析2019年8月—2020年12月收治的78例TE患者的临床资料,其中52例术后未发生肺损伤组(对照组),15例术后发生ALI(ALI组),11例术后发生ARDS(ARDS组),分析三组患者的临床指标与外周血SP-D、SP-A、IL-1β水平的动态变化。通过受试者工作曲线(ROC)及相关性分析评判各观察指标对TE术后伴发ALI/ARDS的早期预测价值及病情严重程度评估效能。结果:各组患者年龄、性别、BMI、致伤因素、损伤部位、手术方式、手术时长及术中出血量差异无统计学意义(均P>0.05),而机械通气时长、降钙素原(PCT)水平、肺损伤预测评分(LIPS)及肺损伤评分(LIS)在对照组、ALI组、ARDS组依次增加,而氧合指数在对照组、ALI组、ARDS组依次降低,差异均有统计学意义(均P<0.05)。术前及术后1、4、7 d的SP-D、SP-A、IL-1β水平在ALI组、ARDS组依次且持续增高,除ALI组与ARDS组术后7 d的SP-A水平差异无统计学意义外(P>0.05),其余差异均有统计学意义(均P<0.05)。ROC曲线分析显示,SP-D、SP-A、IL-1β水平早期预测ALI/ARDS的曲线下面积(0.800、0.919、0.755/0.902、0.931、0.957)均高于PCT(0.739/0.721)及LIPS评分(0.851/0.788),三者联合进行平行试验可提高预测ALI/ARDS的灵敏度至0.997/0.988,三者联合进行系列试验可提高预测ALI/ARDS的特异度至0.999/0.997。相关性分析提示,SP-D、SP-A、IL-1β三项指标与氧合指数均呈明显负相关(r=-0.504、-0.657、-0.717,均P<0.01)、与LIS评分呈明显正相关(r=0.471、0.654、0.634,均P<0.01)。结论:血清SP-D、SP-A、IL-1β检测Background and Aims:Acute lung injury(ALI)/acute respiratory distress syndrome(ARDS)always occurs in patients with traumatic enterorrhexis(TE)after surgery,which is life-threatening.So,selecting the appropriate indicators for early prediction and severity evaluation is of great importance This study was conducted to investigate the value of dynamic detection of surfactant protein-D(SP-D),surfactant protein-A(SP-A)and interleukin-1β(IL-1β)in peripheral blood for early prediction and severity evaluation of ALI/ARDS in TE patients after surgery.Methods:The clinical data of 78 TE patients treated from August 2019 to December 2020 were retrospective analyzed.Of the patients,no postoperative lung injury occurred in 52 cases(control group),postoperative ALI occurred in 15 cases(ALI group)and ARDS occurred in 11 cases(ARDS group).The clinical data and the dynamic changes in serum levels of SP-D,SP-A and Il-1βin the three groups of patients were analyzed.The early prediction value and severity evaluation efficiency of each variable for occurrence of ALI/ARDS in TE patients after surgery were determined by receiver operating characteristic(ROC)curve and correlation analysis.Results:There were no significant differences in age,sex,BMI,injury factors,injury site,operative time and intraoperative blood loss among the three groups(all P>0.05),while the mechanical ventilation time,procalcitonin(PTC)level,lung injury prediction score(LIPS)and lung injury score(LIS)were successively increased,and the oxygenation index was successively decreased in the order of control group,ALI group and ARDS group,and all differences had statistical significance(all P<0.05),The serum levels of SP-D,SP-A and IL-1βin ALI group before and at 1,4,7 d after surgery were successively and continuously increased in the order of control group,ALI group and ARDS group,and except no statistical significance was reached in SP-A level between ALI group and ARDS group at 7 d after surgery(P>0.05),all remaining differences had statistical significance(all

关 键 词：腹部损伤 肠破裂 急性肺损伤 呼吸窘迫综合征 肺表面活性物质相关蛋白质D 肺表面活性物质相关蛋白质A 白细胞介素1Β 

分 类 号：R656.1[医药卫生—急诊医学]