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

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。

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

ObjectiveTo 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. MethodsTotal 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). ResultsThe 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. ConclusionsSerum 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.