摘要
目的探究肝素结合蛋白(heparin-binding protein,HBP)对创伤性脑出血患者早期合并细菌感染的预测作用。方法前瞻性收集2021年9月至2022年6月山西医科大学第一医院急诊医学中心收治的创伤性脑出血患者,病原学检查明确诊断为细菌感染的患者为感染组,病原学检查为阴性的患者为非感染组。检测入院48 h内的血浆HBP浓度,并收集一般信息及相关化验。比较两组各项指标的差异,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),评估各项指标对患者合并感染的预测价值,并利用多因素Logistic回归分析逐步筛选出有价值的预测指标。结果共85名患者纳入研究,年龄(55.09±1.18)岁,包括男性44例,女性41例。纳入研究的患者中细菌感染39例,非感染46例。感染组的年龄、呼吸频率、创伤严重程度评分、手术、HBP[(33.00±3.49)ng/mL vs.(16.27±1.61)ng/mL,P<0.001]、白细胞、中性粒细胞[(15.32±3.19)×10^(9)/L vs.(6.69±0.57)×109/L,P=0.005]大于非感染组,而格拉斯哥昏迷指数小于非感染组,差异有统计学意义(均P<0.05)。两组间淋巴细胞、红细胞、血小板、降钙素原及凝血指标差异无统计学意义(均P>0.05)。Logistic回归结果示,中性粒细胞(OR=1.252,95%CI:1.075~1.457,P=0.004)与HBP(OR=1.081,95%CI:1.025~1.141,P=0.004)均为创伤性脑出血患者发生感染的独立危险因素。HBP诊断创伤性脑出血早期合并感染的ROC曲线下面积为0.82(95%CI:0.71~0.88),敏感度92.31%,特异度52.17%。结论HBP是急诊创伤性脑出血早期合并细菌感染有价值的预测指标,对现有的检验指标具有较好的补充价值。
Objective To investigate the role of heparin-binding protein(HBP)as a predictor of early bacterial infections in patients with traumatic intracerebral hemorrhage.Methods Patients with traumatic intracerebral hemorrhage admitted to the Emergency Department of the First Hospital of Shanxi Medical University from September 2021 to June 2022 were collected prospectively.Patients with bacterial infection diagnosed by pathogenic examination were classified as the infected group,and those with negative pathogenic examination were classified as the non-infected group.Peripheral blood HBP counts were measured within 48 h of admission,and general information and relevant laboratory tests were collected.The differences of the indicators between the two groups were compared,the receiver operating characteristic(ROC)curve was drawn,the predictive value of the indicators for patients with co-infection was assessed,and the valuable predictors were screened out using multivariate logistic regression analysis.Results Eighty-five patients[44 males and 41 females,aged(55.09±1.18)years],were included in the study.Among the patients included in the study,39 patients had bacterial infection and 46 were non-infected.Patients in the infected group were older,and had more surgeries,higher respiratory rate and injury severity score,and higher levels of HBP[(33.00±3.49)ng/mL vs.(16.27±1.61)ng/mL,P<0.001],leukocytes,and neutrophils[(15.32±3.19)×109/L vs.(6.69±0.57)×109/L,P=0.005]than in the non-infected group,while the Glasgow Coma Scale[(8.72±0.63)vs.(11.37±0.48),P=0.001]was lower than that in the non-infected group,with statistically significant differences(all P<0.05).There was no significant differences in lymphocytes,red blood cells,platelets,calcium,procalcitonin and coagulation indexes between the two groups(all P>0.05).Logistic regression analysis showed that neutrophils(OR=1.252,95%CI:1.075-1.457,P=0.004)and HBP(OR=1.081,95%CI:1.025-1.141,P=0.004)were independent risk factors for infection in patients with traumatic cerebral hemorrhage.The area under ROC curve for HBP of diagnosing early co-infection in patients with traumatic intracerebral hemorrhage was 0.82(95%CI:0.71-0.88),the sensitivity was 92.31%,and the specificity was 52.17%.Conclusions HBP is a valuable predictor of early traumatic intracerebral hemorrhage complicated with bacterial infection in the emergency department,and has a good supplementary value to the existing test indicators.
作者
李荔
田晓曦
冯贵龙
宋艳敏
刘晶晶
王敬文
罗天娥
Li Li;Tian Xiaoxi;Feng Guilong;Song Yanmin;Liu Jingjing;Wang Jingwen;Luo Tian'e(The First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,China;Emergency Medicine Center,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Health Statistics,Shanxi Medical University,Taiyuan 030001,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2023年第5期612-616,共5页
Chinese Journal of Emergency Medicine
基金
国家临床重点专科建设项目(国卫办医函[2013]544号)。
关键词
肝素结合蛋白
创伤
脑出血
感染
Heparin-binding protein
Trauma
Intracerebral hemorrhage
Infection
