标题：脓毒症患者血清HMGB1、sTLT-1、NLR变化及其对并发急性肺损伤的预测价值

      作者：张建新 1，马尚超 1，宋浩 1，殷飞 1，崔俊伟 2    张建新 1，马尚超 1，宋浩 1，殷飞 1，崔俊伟 2新乡医学院第一附属医院重症医学科 1、结核内科 2，河南 卫辉 453100

      卷次： 2024年35卷12期

      【摘要】 目的 探讨脓毒症患者血清高迁移率族蛋白B1 (HMGB1)、可溶性髓样细胞触发受体样转录因子-1(sTLT-1)、中性粒细胞/淋巴细胞比值(NLR)变化及其对并发急性肺损伤(ALI)的预测价值。方法 回顾性分析2022年1月至2023年12月新乡医学院第一附属医院收治的120例脓毒症患者的临床资料，根据住院期间是否发生ALI分为ALI组35例、非ALI组85例。比较ALI组与非ALI组、ALI组不同病情程度患者血清HMGB1、sTLT-1、NLR水平，并采用受试者工作(ROC)曲线分析血清HMGB1、sTLT-1、NLR对脓毒症并发ALI的预测价值。结果 ALI组患者的血清HMGB1、sTLT-1、NLR水平分别为(74.21±11.70) pg/mL、(593.06±82.45) pg/mL、5.13±1.16，明显高于非ALI组的(60.15±7.95) pg/mL、(525.73±54.84) pg/mL、4.08±0.64，差异均有统计学意义(P<0.05)；ALI组中，高危组患者的血清HMGB1、sTLT-1、NLR水平分别为(86.43±5.90) pg/mL、(686.31±23.91) pg/mL、(6.49±1.11)，明显高于中危组的(76.64±11.44) pg/mL、(599.28±88.40) pg/mL、5.27±1.00及低危组的(64.48±5.06) pg/mL、(539.93±35.90) pg/mL、4.27±0.71，且中危组患者均高于低危组，差异均有统计学意义(P<0.05)；血清HMGB1、sTLT-1、NLR联合预测脓毒症并发ALI的曲线下面积(AUC)、敏感度、特异度分别为 0.890、90.60%、92.10%，HMGB1单独检测分别为 0.848、84.70%、77.10%，sTLT-1单独检测分别为0.732、71.40%、68.20%，NLR单独检测分别为0.785、62.90%、84.20%，联合检测高于各指标单独检测(P<0.05)。结论 脓毒症并发ALI患者血清HMGB1、sTLT-1、NLR明显升高，且三者联合检测对并发ALI有较高的预测价值。
      【关键词】 脓毒症；急性肺损伤；高迁移率族蛋白B1；可溶性髓样细胞触发受体样转录因子-1；中性粒细胞/淋巴细胞比值；预测价值
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1736—04

Changes of serum HMGB1, sTLT-1, and NLR in patients with sepsis and their predictive value for acute lunginjury.
ZHANG Jian-xin l, MA Shang-chao 1, SONG Hao 1, YIN Fei 1, CUI Jun-wei 2. Department of Critical CareMedicine 1, Department of Tuberculosis 2, the First Affiliated Hospital of Xinxiang Medical College, Weihui 453100, Henan,CHINA
【Abstract】 Objective To investigate the changes of serum high mobility group protein B1 (HMGB1), solublemyeloid cell trigger receptor-like transcription factor-1 (sTLT-1), and neutrophil/lymphocyte ratio (NLR) in patientswith sepsis and their predictive value for acute lung injury (ALI). Methods The clinical data of 120 patients with sep-sis admitted to the First Affiliated Hospital of Xinxiang Medical College from January 2022 to December 2023 were ret-rospectively analyzed. The patients were divided into ALI group (35 cases) and non-ALI group (85 cases) according towhether ALI occurred during hospitalization. The serum HMGB1, sTLT-1, and NLR levels were compared between theALI group and non-ALI group and among patients with different degrees of disease in ALI group. The predictive valueof serum HMGB1, sTLT-1, and NLR in sepsis complicated with ALI was analyzed by receiver operating characteristic(ROC) curve. Results The serum HMGB1, sTLT-1, and NLR levels in ALI group patients were (74.21±11.70) pg/mL,(593.06±82.45) pg/mL, and 5.13±1.16, which were significantly higher than (60.15±7.95) pg/mL, (525.73±54.84) pg/mL,and 4.08 ± 0.64 in the non-ALI group (P<0.05). In the ALI group, the serum HMGB1, sTLT-1, and NLR levels inhigh-risk group were (86.43±5.90) pg/mL, (686.31±23.91) pg/mL, and 6.49±1.11, which were significantly higher than(76.64±11.44) pg/mL, (599.28±88.40) pg/mL, 5.27±1.00 in the medium-risk group and (64.48±5.06) pg/mL, (539.93±35.90) pg/mL, 4.27±0.71 in the low-risk group; the levels in middle-risk group were significantly higher than those in thelow-risk group; the differences were statistically significant (P<0.05). The area under the curve (AUC), sensitivity, andspecificity to predict complication of ALI in patients with sepsis were 0.890, 90.60%, and 92.10% for serum HMGB1,sTLT-1, and NLR in combination, which were significantly higher than 0.848, 84.70%, and 77.10% for HMGB1 alone,0.732, 71.40%, 68.20% for sTLT-1 alone, and 0.785, 62.90%, 84.20% for NLR alone (P<0.05). Conclusion The se-rum HMGB1, sTLT-1, and NLR are significantly increased in patients with sepsis complicated with ALI, and the com-bined detection of these three factors had high predictive value for complication of ALI.
      【Key words】 Sepsis; Acute lung injury; High mobility group protein B1; Soluble myeloid cells trigger recep-tor-like transcription factor-1; Neutrophil/lymphocyte ratio; Predictive value