中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
15期
1753-1757
,共5页
严重多发伤%多器官功能衰竭%全身炎症反应综合征%细胞因子%白介素 6
嚴重多髮傷%多器官功能衰竭%全身炎癥反應綜閤徵%細胞因子%白介素 6
엄중다발상%다기관공능쇠갈%전신염증반응종합정%세포인자%백개소 6
Serious polytrauma%Multiple organ failure%Systemic inflammatory response syndrome%Cytokine%Interleukin - 6
目的：探讨联合检测外周血中性粒细胞核因子κB（NF -κB）活化水平及白介素（IL）-6水平对严重多发伤患者发生多器官功能障碍综合征（MODS）的预测价值。方法回顾性分析2012年6月—2014年6月入住四川省人民医院急诊外科符合纳入与排除标准的严重多发伤患者60例，分析其临床资料。将患者按照预后分为 MODS 组（22例）和非 MODS 组（38例）。比较两组患者入院时外周血中性粒细胞NF -κB活化水平、IL -6水平、创伤严重度评分（ISS）及急性生理与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分。观察以上指标对预测 MODS 发生的受试者工作特征曲线（ROC 曲线）下面积（AUC），并找出预测 MODS 的最佳截断值；比较联合检测外周血中性粒细胞NF -κB活化水平和 IL -6水平、ISS 得分及 APACHE Ⅱ得分预测 MODS 发生的 AUC 值。结果 MODS 组患者 ISS 得分、APACHE Ⅱ得分、外周血 NF -κB 活化水平及IL -6水平均高于非 MODS 组（P <0.05）。Logistic 回归分析结果显示， ISS 得分、APACHE Ⅱ得分、外周血 NF -κB 活化水平及IL -6水平均不是严重多发伤患者发生 MODS 的影响因素（P >0.05）。ISS 得分、APACHE Ⅱ得分、外周血中性粒细胞 NF -κB 活化水平及IL -6水平预测 MODS 发生的 AUC 分别为0.675〔95% CI =（0.542，0.791）〕、0.758〔95% CI =（0.630，0.859）〕、0.830〔95% CI =（0.710，0.914）〕及0.841〔95% CI =（0.724，0.923）〕。截断值：ISS 得分>20分、APACHE Ⅱ得分>15分、外周血中性粒细胞 NF -κB活化水平>1.17及IL -6水平>24.3μg/ L 时，灵敏度分别为：63.64%、68.18%、77.27%及85.45%，阳性似然比分别为2.20、2.59、3.34及2.13。外周血中性粒细胞 NF -κB 活化水平>1.17的严重多发伤患者 MODS 发生率为81.0%（17/21）；IL -6水平>24.3μg/ L 的严重多发伤患者 MODS 发生率为57.1%（20/35）；同时满足外周血中性粒细胞NF -κB活化水平>1.17及IL -6水平>24.3μg/ L 的严重多发伤患者 MODS 发生率为89.5%（17/19）。ISS 得分>20分及APACHE Ⅱ得分>15分预测患者发生 MODS 的 AUC 分别为0.675〔95% CI =（0.542，0.791）〕及0.758〔95%CI =（0.630，0.859）〕，均低于外周血中性粒细胞 NF -κB 活化水平>1.17联合IL -6水平>24.3μg/ L 预测患者发生MODS 的 AUC〔0.860，95% CI =（0.746，0.936）〕（χ2=2.583、2.089，P =0.010、0.014）。结论相比 ISS 得分及APACHE Ⅱ得分，入院时外周血中性粒细胞 NF -κB 活化水平联合IL -6水平测定对预测严重多发伤患者 MODS 的发生更有价值。
目的：探討聯閤檢測外週血中性粒細胞覈因子κB（NF -κB）活化水平及白介素（IL）-6水平對嚴重多髮傷患者髮生多器官功能障礙綜閤徵（MODS）的預測價值。方法迴顧性分析2012年6月—2014年6月入住四川省人民醫院急診外科符閤納入與排除標準的嚴重多髮傷患者60例，分析其臨床資料。將患者按照預後分為 MODS 組（22例）和非 MODS 組（38例）。比較兩組患者入院時外週血中性粒細胞NF -κB活化水平、IL -6水平、創傷嚴重度評分（ISS）及急性生理與慢性健康狀況評分繫統Ⅱ（APACHE Ⅱ）評分。觀察以上指標對預測 MODS 髮生的受試者工作特徵麯線（ROC 麯線）下麵積（AUC），併找齣預測 MODS 的最佳截斷值；比較聯閤檢測外週血中性粒細胞NF -κB活化水平和 IL -6水平、ISS 得分及 APACHE Ⅱ得分預測 MODS 髮生的 AUC 值。結果 MODS 組患者 ISS 得分、APACHE Ⅱ得分、外週血 NF -κB 活化水平及IL -6水平均高于非 MODS 組（P <0.05）。Logistic 迴歸分析結果顯示， ISS 得分、APACHE Ⅱ得分、外週血 NF -κB 活化水平及IL -6水平均不是嚴重多髮傷患者髮生 MODS 的影響因素（P >0.05）。ISS 得分、APACHE Ⅱ得分、外週血中性粒細胞 NF -κB 活化水平及IL -6水平預測 MODS 髮生的 AUC 分彆為0.675〔95% CI =（0.542，0.791）〕、0.758〔95% CI =（0.630，0.859）〕、0.830〔95% CI =（0.710，0.914）〕及0.841〔95% CI =（0.724，0.923）〕。截斷值：ISS 得分>20分、APACHE Ⅱ得分>15分、外週血中性粒細胞 NF -κB活化水平>1.17及IL -6水平>24.3μg/ L 時，靈敏度分彆為：63.64%、68.18%、77.27%及85.45%，暘性似然比分彆為2.20、2.59、3.34及2.13。外週血中性粒細胞 NF -κB 活化水平>1.17的嚴重多髮傷患者 MODS 髮生率為81.0%（17/21）；IL -6水平>24.3μg/ L 的嚴重多髮傷患者 MODS 髮生率為57.1%（20/35）；同時滿足外週血中性粒細胞NF -κB活化水平>1.17及IL -6水平>24.3μg/ L 的嚴重多髮傷患者 MODS 髮生率為89.5%（17/19）。ISS 得分>20分及APACHE Ⅱ得分>15分預測患者髮生 MODS 的 AUC 分彆為0.675〔95% CI =（0.542，0.791）〕及0.758〔95%CI =（0.630，0.859）〕，均低于外週血中性粒細胞 NF -κB 活化水平>1.17聯閤IL -6水平>24.3μg/ L 預測患者髮生MODS 的 AUC〔0.860，95% CI =（0.746，0.936）〕（χ2=2.583、2.089，P =0.010、0.014）。結論相比 ISS 得分及APACHE Ⅱ得分，入院時外週血中性粒細胞 NF -κB 活化水平聯閤IL -6水平測定對預測嚴重多髮傷患者 MODS 的髮生更有價值。
목적：탐토연합검측외주혈중성립세포핵인자κB（NF -κB）활화수평급백개소（IL）-6수평대엄중다발상환자발생다기관공능장애종합정（MODS）적예측개치。방법회고성분석2012년6월—2014년6월입주사천성인민의원급진외과부합납입여배제표준적엄중다발상환자60례，분석기림상자료。장환자안조예후분위 MODS 조（22례）화비 MODS 조（38례）。비교량조환자입원시외주혈중성립세포NF -κB활화수평、IL -6수평、창상엄중도평분（ISS）급급성생리여만성건강상황평분계통Ⅱ（APACHE Ⅱ）평분。관찰이상지표대예측 MODS 발생적수시자공작특정곡선（ROC 곡선）하면적（AUC），병조출예측 MODS 적최가절단치；비교연합검측외주혈중성립세포NF -κB활화수평화 IL -6수평、ISS 득분급 APACHE Ⅱ득분예측 MODS 발생적 AUC 치。결과 MODS 조환자 ISS 득분、APACHE Ⅱ득분、외주혈 NF -κB 활화수평급IL -6수평균고우비 MODS 조（P <0.05）。Logistic 회귀분석결과현시， ISS 득분、APACHE Ⅱ득분、외주혈 NF -κB 활화수평급IL -6수평균불시엄중다발상환자발생 MODS 적영향인소（P >0.05）。ISS 득분、APACHE Ⅱ득분、외주혈중성립세포 NF -κB 활화수평급IL -6수평예측 MODS 발생적 AUC 분별위0.675〔95% CI =（0.542，0.791）〕、0.758〔95% CI =（0.630，0.859）〕、0.830〔95% CI =（0.710，0.914）〕급0.841〔95% CI =（0.724，0.923）〕。절단치：ISS 득분>20분、APACHE Ⅱ득분>15분、외주혈중성립세포 NF -κB활화수평>1.17급IL -6수평>24.3μg/ L 시，령민도분별위：63.64%、68.18%、77.27%급85.45%，양성사연비분별위2.20、2.59、3.34급2.13。외주혈중성립세포 NF -κB 활화수평>1.17적엄중다발상환자 MODS 발생솔위81.0%（17/21）；IL -6수평>24.3μg/ L 적엄중다발상환자 MODS 발생솔위57.1%（20/35）；동시만족외주혈중성립세포NF -κB활화수평>1.17급IL -6수평>24.3μg/ L 적엄중다발상환자 MODS 발생솔위89.5%（17/19）。ISS 득분>20분급APACHE Ⅱ득분>15분예측환자발생 MODS 적 AUC 분별위0.675〔95% CI =（0.542，0.791）〕급0.758〔95%CI =（0.630，0.859）〕，균저우외주혈중성립세포 NF -κB 활화수평>1.17연합IL -6수평>24.3μg/ L 예측환자발생MODS 적 AUC〔0.860，95% CI =（0.746，0.936）〕（χ2=2.583、2.089，P =0.010、0.014）。결론상비 ISS 득분급APACHE Ⅱ득분，입원시외주혈중성립세포 NF -κB 활화수평연합IL -6수평측정대예측엄중다발상환자 MODS 적발생경유개치。
Objectjve To study the predictive value of peripheral blood neutrophilic leukocyte nuclear factor kappa B (NF - κB)activation status combined with IL - 6 for MODS among patients with severe polytrauma. Methods A total of 60 patients with severe polytrauma who were admitted to Surgical Department of Emergency Center in the People′s Hospital of Sichuan Province from June 2012 to June 2014,were selected as study subjects,all cases med inclusion and exclusion criteria,and their clinical data were retrospectively analyzed. Patients were divided into MODS group(22 cases)and non - MODS group(38 cases)according to prognosis,and the peripheral blood neutrophilic leukocyte NF - κB activation status,level of IL - 6,scores of injury severity scoring(ISS)and Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)were compared between two groups. The receiver operating characteristic curve ( ROC curve) was drawn and aera under the ROC curve( AUC) was calculated to analyze the function of those risk factors in judging the MODS happening among severe polytrauma patients. The best cut - off values of those risk factors for MODS happening were searched. The AUC values according to different peripheral blood neutrophilic leukocyte NF - κB activation status combined with different IL - 6 levels,different scores of ISS and APACHE Ⅱwere compared. Results Levels of peripheral blood neutrophilic leukocyte NF - κB activation and IL - 6,and scores of ISS and APACHE Ⅱ among patients in MODS group were significantly higher than those among patients in non - MODS group( P <0. 05). According to multivariate Logistic regression analysis results,scores of ISS and APACHE Ⅱ,levels of peripheral blood neutrophilic leukocyte NF - κB activation and IL - 6 were not influence factors for the happening of MODS among patients with severe polytrauma(P > 0. 05). The AUC values according to different peripheral blood neutrophilic leukocyte NF - κB activation status combined with different IL - 6 levels, different scores of ISS and APACHE Ⅱ were 0. 675 〔 95% CI= (0. 542,0. 791)〕,0. 758〔95% CI = (0. 630,0. 859)〕,0. 830〔95% CI = (0. 710,0. 914)〕and 0. 841〔95% CI= (0. 724,0. 923)〕,respectively. Using peripheral blood neutrophilic leukocyte NF - κB activation level > 1. 17,IL - 6 level > 24. 3 μg/ L,ISS score > 20 and APACHE Ⅱ score > 15 as cut - off values,the sensitivity was 77. 27% ,85. 45% , 63. 64% and 68. 18% ,respectively,and positive predictive value was 3. 34,2. 13,2. 20 and 2. 59 respectively. Incidence of MODS among severe polytrauma patients with NF - κB activation level > 1. 17 was 80. 9%(17 / 21),incidence of MODS among severe polytrauma patients with IL - 6 level > 24. 3 μg/ L was 57. 1% (20 / 35),and incidence of MODS among severe polytrauma patients with both NF - κB activation level > 1. 17 and IL - 6 level > 24. 3 μg/ L was 89. 5% (17 / 19). The AUC value according to peripheral blood neutrophilic leukocyte NF - κB activation level > 1. 17 combined with IL - 6 level > 24. 3μg/ L for MODS prediction was 0. 860〔95% CI = (0. 746,0. 936)〕,which was significant bigger than that〔0. 675,95% CI= (0. 542,0. 791)〕according to ISS score > 20 and that〔0. 758,95% CI = (0. 630,0. 859)〕according to APACHE Ⅱ, respectively(χ2 = 2. 583,2. 089,P = 0. 010,0. 014). Conclusjon Combination of peripheral blood neutrophilic leukocyte NF - κB activation status and IL - 6 test can be a better indicator of MODS prediction in severe polytrauma patients than traditional ISS and APACHE Ⅱ.
