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中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 308 -314. doi: 10.3877/cma.j.issn.1674-1358.2020.04.008

所属专题： 专题评论； 文献；

论著

人高迁移率族蛋白B1、晚期糖基化终产物受体和C反应蛋白与脑外伤术后肺部感染严重程度的相关性及对预后的评估价值
郭金英1, 李惠霖2, 马良1, 王晋霞1, 张开红1,†()   
  1. 1. 046000　长治市，长治医学院附属和平医院检验科
    2. 030001　太原市，山西医科大学医学影像学系
  • 收稿日期:2019-09-30 出版日期:2020-08-15
  • 通信作者: 张开红

Correlation between human high mobility group protein B1, receptor of advanced glycation endproducts and C-reactive protein and the severity of pulmonary infection after brain trauma surgery and the evaluation to the prognosis

Jinying Guo1, Huilin Li2, Liang Ma1, Jinxia Wang1, Kaihong Zhang1,†()   

  1. 1. Department of Clinical Laboratory, Affiliated Peace Hospital, Changzhi Medical College, Changzhi 046000, China
    2. Department of Medical Imaging, Shanxi Medical University, Taiyuan 030001, China
  • Received:2019-09-30 Published:2020-08-15
  • Corresponding author: Kaihong Zhang
  • About author:
    Corresponding author: Zhang Kaihong, Email:
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引用本文：

郭金英, 李惠霖, 马良, 王晋霞, 张开红. 人高迁移率族蛋白B1、晚期糖基化终产物受体和C反应蛋白与脑外伤术后肺部感染严重程度的相关性及对预后的评估价值[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(04): 308-314.

Jinying Guo, Huilin Li, Liang Ma, Jinxia Wang, Kaihong Zhang. Correlation between human high mobility group protein B1, receptor of advanced glycation endproducts and C-reactive protein and the severity of pulmonary infection after brain trauma surgery and the evaluation to the prognosis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(04): 308-314.

目的

探讨人高迁移率族蛋白B1（HMGB-1）、晚期糖基化终产物受体（RAGE）、C反应蛋白（CRP）与脑外伤术后肺部感染严重程度的相关性及对预后的评估价值。

方法

前瞻性选取2016年5月至2018年5月于长治医学院附属和平医院接受治疗的182例脑外伤术后肺部感染者，根据肺部感染CURB-65评分系统标准将患者分为轻度组（74例）、中度组（60例）和重度组（48例），并根据术后30 d临床结局分为生存组（151例）和死亡组（31例）。比较不同感染程度患者血清HMGB-1、RAGE、CRP水平并分析与肺部感染严重程度的相关性。通过Logistic回归分析明确影响患者死亡的危险因素，以受试者工作特征曲线（ROC）评价HMGB-1、RAGE和CRP对脑外伤术后肺部感染者死亡的预测价值。

结果

重度组患者HMGB-1水平为（10.22 ± 2.35）μg/L，分别高于中、轻度组[（3.89 ± 1.01）μg/L和（2.00 ± 0.40）μg/L]，差异有统计学意义（t = 18.821、29.502，P均< 0.001）；重度组患者RAGE水平为（9.01 ± 2.05）ng/L，分别高于中、轻度组患者[（5.89 ± 1.20）ng/L和（2.12 ± 0.22）ng/L]，差异有统计学意义（t = 9.870、28.722，P均< 0.001）；重度组患者CRP水平为（50.33 ± 10.32）mg/L，分别高于中、轻度组患者[（32.33 ± 8.52）mg/L和（15.20 ± 3.52）mg/L]，差异有统计学意义（t = 9.930、27.010，P均< 0.001）。中度组患者血清HMGB-1、RAGE和CRP水平均高于轻度组（t = 14.744、26.504、15.729，P均< 0.001）；血清HMGB-1、RAGE和CRP水平均与肺部感染CURB-65评分呈正相关（r = 0.696、0.763、0.851，P均< 0.001）。182例患者的病死率为17.03%（31/182）。死亡组患者呼吸机应用、气管切开、低蛋白血症占比均显著高于生存组，年龄、HMGB-1、RAGE、CRP、降钙素原（PCT）水平均高于生存组（P均< 0.05）。Logistic回归分析年龄、呼吸机应用、气管切开、低蛋白血症、HMGB-1、RAGE、CRP和PCT均为导致患者死亡的危险因素（OR = 2.016、2.423、2.252、1.853、2.606、2.199、1.919、1.904，P均< 0.05）。ROC曲线分析显示血清HMGB-1、RAGE和CRP预测脑外伤术后肺部感染者死亡的敏感性分别为78.02%、82.42%和85.16%，特异度分别为56.04%、69.78%和71.98%，曲线下面积（AUC）分别为0.756、0.801和0.882。

结论

血清HMGB-1、RAGE和CRP水平与脑外伤术后肺部感染严重程度呈正相关，且均为导致患者死亡的危险因素，对于预测患者的死亡有较高的临床价值。

关键词: 脑外伤, 肺部感染, 人高迁移率族蛋白B1, 晚期糖基化终产物受体, C反应蛋白
Objective

To investigate the correlation between human high mobility group protein B1 (HMGB-1), receptor of advanced glycation endproducts (RAGE), C-reactive protein (CRP) and the severity of pulmonary infection after brain trauma surgery and to evaluate the prognosis of the disease.

Methods

Total of 182 patients with pulmonary infection after operation of brain trauma who were treated in Affiliated Peace Hospital, Changzhi Medical College from May 2016 to May 2018, prospectively. According to the CURB-65 scoring system for lung infection (CURB-65), patients were divided into mild group (74 cases), moderate group (60 cases) and severe group (48 cases). According to the clinical outcome of 30 days after operation, the patients were divided into survival group (151 cases) and death group (31 cases). The serum levels of HMGB-1, RAGE and CRP in patients with different infection degrees were compared and their correlation between the severity of pulmonary infection were analyzed, respectively. The risk factors of death were determined by Logistic regression analysis and the predictive value of HMGB-1, RAGE and CRP to the death of patients with pulmonary infection after traumatic brain injury were evaluated by receiver operating characteristic curve (ROC).

Results

The level of HMGB-1 of patients in severe group was (10.22 ± 2.35) μg/L, significantly higher than those of moderate group [(3.89 ± 1.01) μg/L] and mild group [(2.00 ± 0.40) μg/L], with significant differences (t = 18.821, 29.502; both P < 0.001). The level of RAGE of patients in severe group was (9.01 ± 2.05) ng/L, significantly higher than those of in moderate group [(5.89 ± 1.20) ng/L] and mild group [(2.12 ± 0.22) ng/L], with significant differences (t = 9.870, 28.722; both P < 0.001). The level of CRP of patients in severe group was (50.33 ± 10.32) mg/L, significantly higher than those of the moderate group [(32.33 ± 8.52) mg/L] and mild group [(15.20 ± 3.52) mg/L], with significant differences (t = 9.930, 27.010; both P < 0.001). The serum levels of HMGB-1, RAGE and CRP of patients in moderate group were all higher than those of mild group, with significant differences (t = 14.744, 26.504, 15.729; all P < 0.001). The serum levels of HMGB-1, RAGE and CRP were positively correlated with the CURB-65 score of pulmonary infection (r = 0.696, 0.763, 0.851; all P < 0.001). The fatality rate of 182 patients was 17.03% (31/182). The proportion of ventilator application, tracheotomy and hypoproteinemia of death patients were higher than those of survival cases, and the age, levels of HMGB-1, RAGE, CRP and procalcitonin (PCT) were higher than those of survival group, with significant differences (all P < 0.05). Logistic regression analysis showed that age, proportion of ventilator application, tracheotomy, hypoproteinemia, HMGB-1, RAGE, CRP and PCT were all risk factors to death (OR = 2.016, 2.423, 2.252, 1.853, 2.606, 2.199, 1.919, 1.904, all P < 0.05). ROC analysis showed that the sensitivity of serum HMGB-1, RAGE and CRP in predicting the death of patients with pulmonary infection after brain trauma surgery were 78.02%, 82.42% and 85.16%, respectively, the specificities were 56.04%, 69.78% and 71.98%, respectively, while the area under AUC were 0.756, 0.801 and 0.882, respectively.

Conclusions

Serum HMGB-1, RAGE and CRP were positively correlated with the severity of lung infection after traumatic brain surgery, and were risk factors for death, which had a high clinical value for predicting death.

Key words: Brain trauma, Pulmonary infection, Human high mobility group protein B1, Receptor of advanced glycation endproducts, C-reactive protein
表1 Logistic回归分析法赋值
自变量 赋值 自变量 赋值
性别 女= 0，男= 1 抗菌药物使用 联合应用= 0，单用= 1
年龄 连续变量 留置胃管 否= 0，是= 1
吸烟 否= 0，是= 1 GCS 连续变量
饮酒 否= 0，是= 1 低蛋白血症 否= 0，是= 1
呼吸机应用 否= 0，是= 1 术前血糖水平 连续变量
手术时间 连续变量 HMGB-1水平 连续变量
气管切开 否= 0，是= 1 RAGE水平 连续变量
手术史 否= 0，是= 1 CRP水平 连续变量
肺部疾病史 否= 0，是= 1 PCT水平 连续变量
表2 各组患者血清HMGB-1、RAGE和CRP水平（ ± s）
组别 例数 HMGB-1（μg/L） RAGE（ng/L） CRP（mg/L）
轻度组 74 2.00 ± 0.40 2.12 ± 0.22 15.20 ± 3.52
中度组 60 3.89 ± 1.01 5.89 ± 1.20 32.33 ± 8.52
重度组 48 10.22 ± 2.35 9.01 ± 2.05 50.33 ± 10.32
F值 ? 550.869 446.626 274.440
P值 ? < 0.001 < 0.001 < 0.001
图1 血清HMGB-1、RAGE、CRP水平与CURB-65评分相关性分析散点图
表3 生存组与死亡组患者的预后影响因素
影响因素 死亡组（31例） 生存组（151例） 统计量 P值
男性[例（%）] 17（54.84） 85（56.29） χ2 = 0.022 0.882
年龄（ ± s，岁） 55.85 ± 8.52 39.40 ± 9.01 t = 9.342 < 0.001
吸烟[例（%）] 18（58.06） 92（60.93） χ2 = 0.088 0.767
饮酒[例（%）] 15（48.39） 88（58.28） χ2 = 1.024 0.311
呼吸机应用[例（%）] 22（70.97） 58（38.41） χ2 = 11.067 0.001
手术时间（ ± s，min） 180.36 ± 30.52 175.63 ± 32.10 t = 0.753 0.452
气管切开[例（%）] 20（64.52） 45（29.80） χ2 = 13.500 < 0.001
手术史[例（%）] 5（16.13） 38（25.17） χ2 = 1.164 0.281
肺部疾病史[例（%）] 12（38.71） 42（27.81） χ2 = 1.463 0.226
联合应用抗菌药物[例（%）] 28（90.32） 140（92.72） χ2 = 0.207 0.649
留置胃管[例（%）] 17（54.84） 85（56.29） χ2 = 0.022 0.882
GCS（ ± s，分） 8.85 ± 2.01 9.27. ± 2.20 t = 0.982 0.328
低蛋白血症[例（%）] 12（38.71） 18（11.92） χ2 = 13.408 < 0.001
术前血糖（ ± s，mmol/L） 8.52 ± 2.01 7.85 ± 2.32 t = 1.496 0.136
HMGB-1（ ± s，μg/L） 8.85 ± 1.95 3.96 ± 1.00 t = 20.475 < 0.001
RAGE（ ± s，ng/L） 7.50 ± 1.68 4.70 ± 1.08 t = 11.824 < 0.001
CRP（ ± s，mg/L） 40.32 ± 8.01 28.02 ± 5.45 t = 10.478 < 0.001
PCT（ ± s，ng/ml） 8.85 ± 2.58 15.33 ± 4.12 t = 8.414 < 0.001
表4 影响患者死亡危险因素的Logistic回归分析
自变量 β值 SE值 Wald χ2值 P值 OR值 95%CI
年龄 0.617 0.210 8.632 0.012 1.853 1.512～3.240
呼吸机应用 0.701 0.228 9.453 0.007 2.016 1.565～3.520
气管切开 0.885 0.240 13.598 < 0.001 2.423 1.688～4.896
低蛋白血症 0.812 0.230 12.464 < 0.001 2.252 1.655～4.772
HMGB-1 0.958 0.241 15.801 < 0.001 2.606 1.758～5.985
RAGE 0.788 0.245 10.345 0.001 2.199 1622～3.908.
CRP 0.652 0.217 9.028 0.005 1.919 1.590～3.674
PCT 0.644 0.215 8.872 0.008 1.904 1.556～3.582
图2 不同检测指标对脑外伤术后肺部感染者死亡预测的ROC曲线
表5 不同检测指标对脑外伤术后肺部感染者死亡的预测价值
方法 最佳截断点 敏感性（%） 特异度（%） AUC 95%CI
CRP 7.52 μg/L 85.16 71.98 0.882 0.420～0.938
RAGE 6.88 ng/L 82.42 69.78 0.801 0.410～0.885
HMGB-1 36.45 mg/L 78.02 56.04 0.756 0.398～0.802
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