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外周血高迁移率族蛋白B1联合髓样细胞分化蛋白88预测严重多发伤患者多器官功能障碍综合征的价值

Prediction value of high-mobility group box 1 combined with myeloid differentiation protein 88 in peripheral blood for multiple organ dysfunction syndrome in patients with severe multiple trauma

    摘要
  • 摘要:
    目的 探讨外周血高迁移率族蛋白B1(HMGB1)、髓样细胞分化蛋白88(MyD88)表达水平预测严重多发伤患者合并多器官功能障碍综合征(MODS)的价值。
    方法 前瞻性分析2018年11月—2023年10月九江171医院收治的156例受伤至入院时间≤24 h的严重多发伤患者, 根据入院期间(7 d)合并MODS情况分为合并MODS组84例和未合并MODS组72例。采用酶联免疫吸附法(ELISA)检测2组患者入院24 h内血清HMGB1、MyD88表达水平; 采用Spearman和Pearson相关性分析探讨血清HMGB1、MyD88水平与急性生理学及慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、创伤严重程度评分(ISS)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、C反应蛋白(CRP)的相关性; 采用多因素Logistic回归分析筛选影响严重多发伤合并MODS的因素; 采用受试者工作特征(ROC)曲线分析血清HMGB1、MyD88水平对严重多发伤合并MODS的预测价值。
    结果 合并MODS组APACHE Ⅱ评分、ISS、TNF-α、IL-10、CRP水平高于未合并MODS组，差异有统计学意义(P < 0.001)。合并MODS组血清HMGB1、MyD88水平高于未合并MODS组，差异有统计学意义(P < 0.05)。Spearman相关性分析显示，血清HMGB1、MyD88水平与APACHE Ⅱ评分、ISS呈显著正相关(P < 0.001); Pearson相关性分析显示，血清HMGB1、MyD88水平与TNF-α、IL-10、CRP呈显著正相关(P < 0.001)。多因素Logistic回归分析显示，血清HMGB1、MyD88、APACHE Ⅱ评分、ISS、CRP均是影响严重多发伤合并MODS的危险因素(均P < 0.05)。血清HMGB1预测严重多发伤合并MODS的曲线下面积(AUC)为0.741(95%CI: 0.665~0.808), 最佳截断值为14.35 μg/L, 灵敏度和特异度分别为59.52%、84.72%; MyD88预测严重多发伤合并MODS的AUC为0.819(95%CI: 0.749~0.876), 最佳截断值为5.06 ng/mL, 灵敏度和特异度分别为65.48%、87.50%; 血清HMGB1联合MyD88预测严重多发伤合并MODS的AUC为0.903(95%CI: 0.845~0.945), 灵敏度和特异度分别为89.29%、81.94%, 显著高于2项指标单独预测(Z二者联合-HMGB1=4.470、Z二者联合-MyD88=2.611, 均P < 0.05)。
    结论 严重多发伤合并MODS患者血清HMGB1、MyD88表达水平均显著升高，均是影响MODS发生的危险因素，且二者联合具有较高的MODS预测价值。

     

    Abstract:
    Objective To investigate the predictive values of expression levels of high-mobility group box 1 (HMGB1) and myeloid differentiation protein 88 (MyD88) in peripheral blood for multiple organ dysfunction syndrome (MODS) in patients with severe multiple trauma.
    Methods A prospective analysis was conducted in 156 patients with severe multiple trauma in the 171 Hospital of Jiujiang from November 2018 to October 2023, with a duration less than 24 hours from injury to hospital admission. Patients were divided into two groups based on the presence (84 cases) or absence (72 cases) of MODS during hospitalization (7 days). Enzyme-linked immunosorbent assay (ELISA) was used to measure serum HMGB1 and MyD88 levels within 24 hours after admission. Spearman and Pearson correlation analyses were used to explore the relationships of serum HMGB1 and MyD88 levels with the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, the Injury Severity Score (ISS), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), and C-reactive protein (CRP). Multivariate Logistic regression analysis was used to identify factors influencing the development of MODS in severe multiple trauma.The predictive values of serum HMGB1 and MyD88 levels for MODS in severe multiple trauma were assessed using receiver operating characteristic (ROC) curve analysis.
    Results The MODS group had significantly higher APACHE Ⅱ score, ISS score, and TNF-α, IL-10 and CRP levels compared to the non-MODS group (P < 0.001). Serum HMGB1 and MyD88 levels were also significantly elevated in the MODS group (P < 0.05). Spearman correlation analysis revealed significant positive correlations of serum HMGB1 and MyD88 levels with the APACHE Ⅱ score and ISS score (P < 0.001). Pearson correlation analysis showed significant positive correlations of serum HMGB1 and MyD88 levels with TNF-α, IL-10 and CRP (P < 0.001). Multivariate Logistic regression analysis indicated that serum HMGB1, MyD88, APACHE Ⅱ score, ISS score, and CRP were all risk factors for MODS in severe multiple trauma (all P < 0.05). The area under the curve (AUC) of ROC curve for serum HMGB1 in predicting MODS in severe multiple trauma was 0.741 (95%CI, 0.665 to 0.808), with an optimal cut-off value of 14.35 μg/L, sensitivity of 59.52%, and specificity of 84.72%. The AUC for MyD88 was 0.819 (95%CI, 0.749 to 0.876), with an optimal cut-off value of 5.06 ng/mL, sensitivity of 65.48%, and specificity of 87.50%. The combined prediction of serum HMGB1 and MyD88 yielded an AUC of 0.903 (95%CI, 0.845 to 0.945) with sensitivity of 89.29% and specificity of 81.94%, which was significantly higher than value of each marker alone (Zcombined-HMGB1=4.470, Zcombined-MyD88=2.611, both P < 0.05).
    Conclusion Serum HMGB1 and MyD88 levels are significantly elevated in patients with severe multiple trauma complicated by MODS, and increased HMGB1 and MyD88 levels are risk factors for MODS development. The combination of two markers exhibits high predictive value for MODS.

     

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