创伤早期肺特异性相关蛋白测定对识别和量化肺挫伤的价值初探

目的通过分析创伤早期肺特异性相关蛋白——克拉拉蛋白（CCl6）、表面活性蛋白D（sP—D）、高级糖基化终末产物可溶性性受体（sRAGE）的血清浓度与肺挫伤和挫伤体积的相关关系，以探讨其对诊断和量化肺挫伤的价值。方法以无吸烟史健康受试者为对照组（15例），根据急诊初次胸部CT结果，将多发伤患者分为肺挫伤组（31例）和无肺挫伤组（15例），同时采集静脉血样，检测血清CCl6、SP—D和sRAGE的浓度，比较3组问3种肺特异性相关蛋白的差异性，并对其与肺挫伤和挫伤体积进行相关分析，得出敏感指标的ROC曲线。结果3种肺特异性相关蛋白中，只有CCl6的血清浓度在3组间有明显统计学差异，并与肺挫伤体积正相关，肺挫伤是血清CCl6浓度升高的独立影响因素。CCl6的ROC的曲线下面积为0．890，诊断灵敏度为0．935，特异度为0．800。结论CCl6有望成为辅助临床诊断肺挫伤的生物学标志物。

The value of the determination of the lung specific proteins for identifying and quantifying pulmonary contusion

Objective Through analyzing the changes in serum concentrations of lung specific proteins- Clara cell secretory protein（CC16） ,surfactant protein D{ SP-D} , soluble receptor for advanced glycation end-prod- ucts/sRAGE } after pulmonary contusion, and its correlation with the pulmonary contusion and contusion volume, to investigate its value in diagnosing and quantifying the pulmonary contusion. Methods Non-smoking healthy volun- teers are taken as controls, and patients with multiple injuries were divided into those with pulmonary contusion（PC group, n = 31 ） and without pulmonary contusion （ NPC group, n = 15 ） depending on the results of the initial CT ima- ges. Venous blood samples were collected at the same time. The serum levels of CC16,SP-D and sRAGE were test- ed. The difference of the three lung specific proteins in serum levels was compared among three groups, its correla- tion with both the contusion diagnosis and volume was analyzed, and the ROC curve of sensitive indicator was ob- tained. Results Only the CC16 serum levels had a significant statistical difference among three groups,which was positively correlated with lung contusion volume. Pulmonary contusion was the only factor that had a statistically sig- nificant effect on CC16 serum levels. ROC analysis of CC16 revealed an area under the curve of 0. 890, a cutoff val- ue of 12. 622ng/ml,which had a sensitivity of 0. 935 and a specificity of 0. 800. Conclusion CC16 is a promising diagnostic biomarker for the clinical diagnosis of pulmonary contusion.