摘要
目的研究肠道菌群紊乱与急诊严重创伤患者多器官功能障碍综合征(MODS)发生的相关性,为临床防治MODS提供指导。方法回顾性选取2023年1月—2025年2月金华市中心医院收治的162例急诊严重创伤患者的临床资料,统计MODS发生率;根据是否发生MODS,分为MODS组与非MODS组,对比两组入院时的临床资料[性别、年龄、受伤原因、受伤至入院时间、创伤严重程度(ISS)评分、休克持续时间、感染、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、双歧杆菌、乳酸杆菌、大肠杆菌、金黄色葡萄球菌];多因素logistic回归分析评估影响MODS发生的相关因素;绘制受试者工作特征(ROC)曲线分析肠道菌群紊乱对MODS的预测价值。结果162例患者中,发生MODS共38例,MODS发生率为23.46%(38/162)。两组受伤原因、受伤至入院时间、ISS评分、休克持续时间、感染情况、CRP、PCT、IL-6、TNF-α水平,双歧杆菌、乳酸杆菌、大肠杆菌、金黄色葡萄球菌数量比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,高处坠落伤、受伤至入院时间长、ISS评分高、休克持续时间长、感染,CRP、PCT、IL-6和TNF-α升高,大肠杆菌和金黄色葡萄球菌数量增多是急诊严重创伤患者发生MODS的危险因素(均P<0.05),双歧杆菌、乳酸杆菌数量增多是其保护因素(均P<0.05)。ROC曲线分析显示,双歧杆菌、乳酸杆菌、大肠杆菌、金黄色葡萄球菌联合检测预测MODS发生的曲线下面积(AUC)、灵敏度、特异度分别为0.911、86.69%、85.01%。结论肠道菌群紊乱与急诊严重创伤患者MODS发生密切相关,监测肠道菌群变化有助于预测MODS的发生。
ObjectiveTo investigate the correlation between gut microbiota dysbiosis and the occurrence of multiple organ dysfunction syndrome(MODS)in emergency patients with severe trauma,and to provide guidance for clinical prevention and treatment of MODS.MethodsA retrospective analysis was conducted on the clinical data of 162 emergency patients with severe trauma admitted to the Jinhua Municipal Central Hospital from January 2023 to February 2025.The incidence of MODS was calculated.Patients were divided into MODS group and non-MODS group based on whether MODS occurred.Clinical data at admission were compared between the two groups,including gender,age,cause of injury,time from injury to admission,Injury Severity Score(ISS),duration of shock,infection,C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),Bifidobacterium,Lactobacillus,Escherichia coli,and Staphylococcus aureus.Multivariate logistic regression analysis was performed to evaluate factors associated with MODS occurrence.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of gut microbiota dysbiosis for MODS.ResultsAmong the 162 patients,38 developed MODS,with an incidence rate of 23.46%(38/162).Significant differences were found between the two groups in terms of cause of injury,time from injury to admission,ISS score,duration of shock,infection status,levels of CRP,PCT,IL-6,and TNF-α,as well as the counts of Bifidobacterium,Lactobacillus,Escherichia coli,and Staphylococcus aureus(all P<0.05).Multivariate logistic regression analysis showed that fall from height,prolonged time from injury to admission,high ISS score,long duration of shock,infection,elevated levels of CRP,PCT,IL-6,and TNF-α,and increased counts of Escherichia coli and Staphylococcus aureus were risk factors for MODS in emergency patients with severe trauma(all P<0.05),while increased counts of Bifidobacterium and Lactobacillus were protective factors(all P<0.05).ROC curve analysis showed that the combined detection of Bifidobacterium,Lactobacillus,Escherichia coli,and Staphylococcus aureus for predicting MODS had an area under the curve(AUC)of 0.911,sensitivity of 86.69%,and specificity of 85.01%.ConclusionsGut microbiota dysbiosis is closely associated with the occurrence of MODS in emergency patients with severe trauma.Monitoring changes in gut microbiota may help predict the occurrence of MODS.
作者
丁颖威
何建涛
张骏
李秀花
陈钢
Ding Yingwei;He Jiantao;Zhang Jun;Li Xiuhua;Chen Gang(Department of Emergency,Jinhua Municipal Central Hospital,Jinhua 321000,China)
出处
《中国医师杂志》
2026年第2期253-257,共5页
Journal of Chinese Physician
基金
金华市公益性技术应用研究项目(2022-4-110)。
关键词
多器官功能障碍综合征
肠道菌群
创伤和损伤
危险因素
Multiple organ dysfunction syndrome
Gastrointestinal microbiome
Wounds and injuries
Risk factors
