血清Del-1联合NISS评分对创伤患者近期预后的预测价值分析  

Predictive value of serum Del-1 combined with NISS score for short-term prognosis in trauma patients

作　　者：刘鹏 刘萍[2] 邵红 史光军[4] 王丰艳 Liu Peng;Liu Ping;Shao Hong;Shi Guang-jun;Wang Feng-yan(Department of Emergency,Qingdao Municipal Hospital(Qingdao Geriatric Hospital),Qingdao,Shandong 266001,China;Department of Geriatrics,Qingdao Municipal Hospital,Qingdao,Shandong 266011,China;Department of Medical Care,Qingdao Cadre Health Service Center,Qingdao,Shandong 266071,China;Department of Hepatobiliary Surgery,East Hospital of Qingdao City Hospital,Qingdao,Shandong 266071,China)

机构地区：[1]青岛市市立医院(青岛市老年病医院)急诊科 [2]青岛市市立医院干保老年医学科 [3]青岛市干部保健服务中心医疗保健科 [4]青岛市市立医院东院区肝胆外科

出　　处：《中国现代医学杂志》2025年第5期66-71,共6页China Journal of Modern Medicine

基　　金：山东省自然科学基金(No:ZR202103030420)。

摘　　要：目的探讨血清内皮发育调节基因-1(Del-1)联合新损伤严重程度评分(NISS)对创伤患者近期预后的预测价值。方法选取2021年6月—2024年5月青岛市市立医院收治的204例创伤患者为研究对象,根据随访28 d的预后情况分为存活组183例和死亡组21例。比较两组患者的临床资料、血清Del-1水平及NISS评分;绘制受试者工作特性(ROC)曲线评估血清Del-1、NISS评分对创伤患者近期预后的预测价值;采用多因素Logistic逐步回归模型分析创伤患者近期预后的影响因素。结果死亡组年龄≥60岁占比、受伤至入院时间、呼吸机辅助通气率、创伤严重程度均高于存活组,收缩压、舒张压、平均动脉压、GCS评分、NE水平和D-二聚体水平均高于存活组(P<0.05)。死亡组血清Del-1水平低于存活组,NISS评分高于存活组(P<0.05)。血清Del-1、NISS评分及二者联合预测创伤患者近期预后的曲线下面积分别为0.859、0.746和0.906,特异性分别为63.71%、58.15%和85.02%,敏感性分别为93.41%、93.41%和87.11%。多因素Logistic逐步回归分析显示,受伤至入院时间长[O^R=1.958(95%CI:1.414,2.711)]、有呼吸机辅助通气[O^R=2.106(95%CI:1.474,3.009)]、GCS评分高[O^R=2.502(95%CI:1.651,3.791)]、创伤严重程度重[O^R=2.385(95%CI:1.589,3.578)]、Del-1水平降低[O^R=0.299(95%CI:0.184,0.484)]、NISS评分高[O^R=2.866(95%CI:1.848,4.446)]是创伤患者死亡的独立危险因素(P<0.05)。结论血清Del-1、NISS评分可作为创伤患者近期预后的预测因子,且二者联合预测价值更高。Objective To explore the predictive value of serum developmental endothelial locus-1 (Del-1)combined with the New Injury Severity Score (NISS) for short-term prognosis in trauma patients.Methods A total of 204 trauma patients admitted to Qingdao Municipal Hospital from June 2021 to May 2024 were enrolled.Based on 28-day follow-up outcomes,patients were divided into a survival group (n=1 83) and a death group (n=21).Clinical data,serum Del-1 levels,and NISS scores were compared between the two groups.Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of serum Del-1 and NISS scores for short-term prognosis.Multivariate stepwise logistic regression was used to identify independent risk factors for prognosis.Results The death group had a higher proportion of patients aged≥60 years,longer injury-to-admission time,higher rates of ventilator assistance,and greater trauma severity compared to the survival group.Systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP),Glasgow Coma Scale (GCS) scores,neutrophil elastase (NE) levels,and D-dimer levels were significantly higher in the death group (all P<0.05).Serum Del-1 levels were lower (P<0.05) and NISS scores were higher (P<0.05) in the death group.The areas under the ROC curve (AUCs) for Del-1,NISS,and their combination were 0.859,0.746,and 0.906,respectively,with specificities of 63.71%,58.15%,and 85.02%,and sensitivities of 93.41%,93.41%,and 87.11%.Multivariate analysis identified independent risk factors for mortality:prolonged injury-to-admission time[O^R=1.958(95%CI:1.414,2.711)],ventilator assistance[O^R=2.106(95%CI:1.474,3.009)],higher GCS score[O^R=2.502(95%CI:1.651,3.791)],severe trauma[O^R=2.385(95%CI:1.589,3.578)],reduced Del-1[O^R=0.299(95%CI:0.184,0.484)],and elevated NISS score [O^R=2.866(95%CI:1.848,4.446)](all P<0.05).Conclusion Serum Del-1and NISS scores are effective predictors of short-term prognosis in trauma patients,with enhanced predictive power when combined.

关 键 词：创伤 内皮发育调节基因-1 新损伤严重程度评分 预后 

分 类 号：R641[医药卫生—外科学]