外周血中性粒细胞核因子κB 活化水平联合白介素6水平测定对严重多发伤患者发生多器官功能障碍综合征的预测价值

摘要

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。%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.