摘要
目的 分析高海拔地区创伤患者单核细胞免疫表型、炎症因子水平与创伤严重程度及预后的关系。方法 选取2022年1月至2024年8月该院收治的高海拔地区创伤患者80例作为创伤组,根据创伤严重程度评分(ISS)将其分为轻度组(40例)、中度组(25例)和重度组(15例),另选取同期于该院进行常规体检的健康者80例作为对照组。比较各组中性粒细胞与淋巴细胞比值(NLR)、单核细胞表面人类白细胞抗原-DR(HLA-DR)阳性率、CD64的平均荧光强度(MFI),以及白细胞介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α水平。采用Spearman相关分析创伤患者上述指标与创伤严重程度的关系。评估创伤组患者28 d的预后情况,采用受试者工作特征(ROC)曲线分析各指标对创伤组患者死亡的预测价值。结果 创伤组HLA-DR阳性率低于对照组(P<0.05),CD64 MFI、NLR以及血清IL-6、IL-10、TNF-α水平均高于对照组(P<0.05)。轻度组HLA-DR阳性率高于中度组、重度组(P<0.05),CD64 MFI、NLR及血清IL-6、IL-10、TNF-α水平低于中度组、重度组(P<0.05),且与中度组比较,重度组HLA-DR阳性率更低(P<0.05),CD64 MFI、NLR及血清IL-6、IL-10、TNF-α水平均更高(P<0.05)。Spearman相关分析结果显示,创伤患者HLA-DR阳性率与创伤严重程度呈负相关(P<0.05),CD64 MFI、NLR及IL-6、IL-10、TNF-α水平与创伤严重程度呈正相关(P<0.05)。80例创伤患者28 d的病死率为13.75%(11/80)。生存组HLA-DR阳性率高于死亡组(P<0.05),CD64 MFI、NLR及血清IL-6、IL-10、TNF-α水平均低于死亡组(P<0.05)。ROC曲线分析结果显示,HLA-DR、CD64、NLR、IL-6、IL-10、TNF-α预测创伤患者死亡的曲线下面积(AUC)分别为0.773、0.788、0.744、0.768、0.736和0.781(P<0.05)。结论 高海拔地区创伤患者存在明显的单核细胞免疫表型失调及全身炎症反应,且均与创伤严重程度及预后密切相关。
Objective To analyze the relationship between monocyte immunophenotypes,inflammatory cytokine levels,trauma severity and prognosis in trauma patients from high-altitude areas.Methods A total of 80 trauma patients from high-altitude areas who were admitted to the hospital from January 2022 to August 2024 were selected for the trauma group.Based on the Injury Severity Score(ISS),the patients were divided into three subgroups:mild(40 cases),moderate(25 cases)and severe(15 cases).Another 80 healthy individuals who underwent routine physical examinations at the hospital during the same period were selected as the control group.The neutrophil-to-lymphocyte ratio(NLR),human leukocyte antigen-DR(HLA-DR)positivity rate on monocyte surfaces,the mean fluorescence intensity(MFI)of CD64,and the levels of interleukin(IL)-6,IL-10 and tumor necrosis factor(TNF)-αwere compared among the groups.Spearman correlation analysis was performed to assess the relationship between these indicators and trauma severity of trauma patients.The 28 d prognosis of patients in the trauma group was evaluated,and the predictive value of each indicator for the death of trauma patients was analyzed using receiver operating characteristic(ROC)curve.Results The HLA-DR positivity rate in the trauma group was lower than that in the control group(P<0.05),while the CD64 MFI,NLR and serum levels of IL-6,IL-10 and TNF-αwere higher in the trauma group compared with those in the control group(P<0.05).In the mild subgroup,the HLA-DR positivity rate was higher than that in the moderate and severe subgroups(P<0.05),while CD64 MFI,NLR and serum levels of IL-6,IL-10 and TNF-αwere lower than those in the moderate and severe subgroups(P<0.05).Furthermore,compared with the moderate subgroup,the severe subgroup had a lower HLA-DR positivity rate(P<0.05)and higher CD64 MFI,NLR and levels of serum IL-6,IL-10 and TNF-α(P<0.05).Spearman correlation analysis showed that the HLA-DR positivity rate was negatively correlated with trauma severity(P<0.05),while CD64 MFI,NLR,and IL-6,IL-10 and TNF-αlevels were positively correlated with trauma severity(P<0.05)in trauma patients.The 28 d mortality rate of the 80 trauma patients was 13.75%(11/80).The HLA-DR positivity rate in the survival group was higher than in the death group(P<0.05),while CD64 MFI,NLR,and serum levels of IL-6,IL-10 and TNF-αwere lower in the survival group compared with those in the death group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for HLA-DR,CD64,NLR,IL-6,IL-10 and TNF-αin predicting death in trauma patients were 0.773,0.788,0.744,0.768,0.736 and 0.781 respectively(P<0.05).Conclusion Trauma patients from high-altitude areas exhibit significant monocyte immunophenotype dysregulation and systemic inflammatory response,both of which are closely associated with trauma severity and prognosis.
作者
石海霞
仲盛年
赵永峰
李艺群
马海军
吴海涛
SHI Haixia;ZHONG Shengnian;ZHAO Yongfeng;LI Yiqun;MA Haijun;WU Haitao(Department of Emergency,Affiliated Hospital of Qinghai University,Xining,Qinghai 810001,China;Emergency ICU,Affiliated Hospital of Qinghai University,Xining,Qinghai 810001,China;Department of Ultrasound,Affiliated Hospital of Qinghai University,Xining,Qinghai 810001,China)
出处
《检验医学与临床》
2025年第24期3367-3372,共6页
Laboratory Medicine and Clinic
基金
青海省卫生健康委员会一般指导性课题(2020-wjzdx-54)。
