血清sTLT-1、SP-D、NF-κB水平在脓毒症急性肺损伤预后评估中的价值  

Evaluation value of serum sTLT-1,SP-D and NF-κB for prognosis of sepsis combined with acute lung injury

作　　者：王晓林[1] 李静 范志强[1] 佟庆[1] 黄艳丽 WANG Xiaolin;LI Jing;FAN Zhiqiang;TONG Qing;HUANG Yanli(Department of Internal Medicine ICU,Qinhuangdao First Hospital,Qinhuangdao 066000,Hebei,China;Department of Pharmacy,Qinhuangdao First Hospital,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市第一医院内科ICU,河北秦皇岛066000 [2]秦皇岛市第一医院药学部,河北秦皇岛066000

出　　处：《西部医学》2024年第12期1781-1785,共5页Medical Journal of West China

基　　金：秦皇岛市科学技术研究与发展计划项目(201902A195)。

摘　　要：目的 探究血清可溶性髓样细胞触发受体样转录因子-1(sTLT-1)、表面活性蛋白-D(SP-D)、核转录因子-κB(NF-κB)水平在脓毒症急性肺损伤(ALI)预后评估中的价值。方法 选择2021年4月—2023年4月来我院就诊脓毒症患者36例作为脓毒症组,选择同期脓毒症并ALI患者80例作为ALI组。比较两组的一般资料、血清sTLT-1、SP-D、NF-κB水平、APACHEⅡ评分、LIPS评分。ALI组患者根据1个月内生存情况,分为死亡组(n=32)和存活组(n=48)。比较死亡组和存活组的一般资料、血清sTLT-1、SP-D、NF-κB水平、APACHEⅡ评分、LIPS评分,分析ALI组预后不良的影响因素及血清学sTLT-1、SP-D、NF-κB指标对ALI预后评估价值。结果 ALI组患者的sTLT-1、SP-D、NF-κB、APACHEⅡ评分、LIPS评分均高于脓毒症组(P<0.05);单因素分析结果显示,ALI患者中死亡组及存活组的性别、年龄、感染部位、吸烟例数及BMI水平比较,差异无统计学意义(P>0.05);ALI患者中死亡组血清sTLT-1、SP-D、NF-κB、APACHEⅡ评分、LIPS评分均高于存活组(P<0.05);多因素分析显示,血清sTLT-1、SP-D、NF-κB、APACHEⅡ评分、LIPS评分是ALI患者预后不良的独立危险因素;采用ROC曲线分析,sTLT-1、SP-D、NF-κB联合诊断ALI预后不良的AUC为0.914,均高于单一sTLT-1、SP-D、NF-κB的0.832、0.796、0.816。结论 血清sTLT-1、SP-D、NF-κB水平与脓毒症ALI的发生及发展相关,同时是其预后不良的独立危险因素,临床联合检测sTLT-1、SP-D、NF-κB三项指标有助于指导ALI预后评估。Objective To explore the evaluation value of serum soluble triggering receptor expressed on myeloid cells-like transcript 1(sTLT-1),surfactant protein-D(SP-D)and nuclear transcription factor-κB(NF-κB)for prognosis of sepsis combined with acute lung injury(ALI).Methods A total of 36 patients with sepsis and 80 patients with sepsis and ALI in the hospital were enrolled as sepsis group and ALI group from April 2021 to April 2023,respectively.The general data,levels of serum sTLT-1,SP-D and NF-κB,scores of APACHEⅡand LIPS in the two groups were compared.According to 1-month survival,patients in ALI group were divided into death group(n=32)and survival group(n=48),and general data,levels of serum sTLT-1,SP-D and NF-κB,scores of APACHEⅡand LIPS in the two groups were compared.The influencing factors of poor prognosis in ALI group and the evaluation value of the three serological indexes for prognosis of ALI were analyzed.Results The levels of sTLT-1,SP-D and NF-κB,scores of APACHEⅡand LIPS in ALI group were higher than those in sepsis group(P<0.05).Univariate analysis showed that there was no significant difference in gender,age,infection sites,number of smoking cases or BMI level between death group and survival group(P>0.05).The levels of sTLT-1,SP-D and NF-κB,scores of APACHEⅡand LIPS in death group were higher than those in survival group(P<0.05).Multivariate analysis showed that serum sTLT-1,SP-D,NF-κB,APACHEⅡscore and LIPS score were independent risk factors of poor prognosis in ALI patients.ROC curves analysis showed that AUC of sTLT-1 combined with SP-D and NF-κB in the diagnosis of poor prognosis was 0.914,greater than that of single index(0.832,0.796,0.816).Conclusion The levels of serum sTLT-1,SP-D and NF-κB are related to the occurrence and development of sepsis combined with ALI,and they are also independent risk factors of poor prognosis.Clinically,combined detection of the three indexes is beneficial to guide the prognosis evaluation of ALI.

关 键 词：脓毒症 急性肺损伤 溶性髓样细胞触发受体样转录因子-1 表面活性蛋白-D 核转录因子-ΚB 预后 

分 类 号：R631[医药卫生—外科学]