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投稿时间：2025-02-14 网络发布日期：2025-08-20
投稿时间：2025-02-14 网络发布日期：2025-08-20
中文摘要: 目的 探讨血清表面活性蛋白D（SP-D）、C-C基序趋化因子配体25（CCL25）及肺血管阻力指数（PVRI）与严重胸外伤合并创伤性湿肺（TWL）患者肺损伤程度及预后的关系，并分析其临床评估价值。方法 选取2020年1月至2024年2月河北医科大学第三医院收治的160例严重胸外伤合并TWL患者，根据肺损伤程度分为轻中度组（n=68）、重度组（n=92）。比较不同肺损伤程度组患者 PVRI、血清 SP-D、CCL25 三项指标以及肺损伤评分（LIS），分析该三项指标与LIS评分的相关性及对TWL患者预后的影响；并分析该三项指标对TWL患者肺损伤程度、预后的评估价值。结果 轻中度组PVRI、血清SP-D、CCL25及LIS评分均低于重度组（P＜0.01）；相关性分析显示，PVRI、血清SP-D、CCL25与LIS评分分别呈正相关（r=0.707、0.776、0.779，P＜0.05）；PVRI、血清SP-D、CCL25联合评估患者重度肺损伤的受试者工作特征（ROC）曲线下面积（AUC）为0.920（95%CI：0.866～0.957），敏感度为 85.87%，特异度为 85.29%。160 例患者中 30 d 内存活 114 例，病亡 46 例；存活组 APACHEⅡ评分、PVRI、血清SP-D、CCL25均低于病亡组（P＜0.01）；Logistic回归性分析结果显示，APACHEⅡ评分、PVRI、血清SP-D、CCL25均为严重胸外伤合并TWL患者病亡的独立影响因素（P＜0.05）；该三项指标联合评估患者预后的AUC为0.939（95%CI：0.890～0.970），敏感度为91.30%，特异度为84.21%。结论 PVRI、血清SP-D、CCL25与严重胸外伤合并TWL患者肺损伤程度显著相关，三者联合对患者肺损伤程度及预后具有较高的评估效能。
Abstract:Objective To explore the relationship between serum surfactant protein D（SP-D），C-C motif chemokine ligand 25（CCL25）and pulmonary vascular resistance index（PVRI）with the degree of lung injury and prognosis in severe chest trauma patients complicated with traumatic wet lung（TWL），and to analyze their clinical evaluation values. Methods A total of 160 patients with severe chest trauma and TWL admitted to Hebei Medical University Third Hospital from January 2020 to February 2024 were enrolled. Based on the severity of lung injury，they were divided into mild-to-moderate group（n=68）and severe group（n=92）. Three indexes（PVRI，serum SP-D，CCL25) and lung injury score（LIS）were compared between different lung injury degree groups，and the correlation of these three indexes with LIS scores and their impact on the prognosis of patients with TWL were analyzed. The predictive values of these three indicators on the degree of lung injury and prognosis of patients with TWL were evaluated. Results The mild - to -moderate group had significantly lower PVRI，serum SP-D，CCL25，and LIS scores compared to the severe group（P<0.01）. Correlation analysis revealed positive associations between PVRI，SP-D，CCL25，and LIS（r=0.707，0.776， 0.779，P<0.05）. The combined assessment of PVRI，SP-D，and CCL25 for severe lung injury yielded an area under the receiver operating characteristic（ROC）curve（AUC）of 0.920（95%CI：0.866-0.957），with a sensitivity of 85.87% and a specificity of 85.29% . Among the 160 patients，114 survived and 46 died within 30 days. The survival group exhibited lower APACHE Ⅱ scores，PVRI，SP-D，and CCL25 levels than the non-survival group（P<0.05）. Logistic regression identified APACHE Ⅱ score，PVRI，SP-D，and CCL25 as independent risk factors for mortality（P<0.05）. The combined assessment of PVRI，SP-D，and CCL25 for prognosis had an AUC of 0.939（95%CI：0.890-0.970），with a sensitivity of 91.30% and specificity of 84.21%. Conclusion PVRI，serum SP-D，and CCL25 are significantly associated with the severity of lung injury in severe chest trauma complicated with TWL and hold high predictive values for both lung injury severity and prognosis.
keywords: Severe chest trauma Traumatic wet lung Lung injury Surfactant protein D C-C motif chemokine ligand 25 Pulmonary vascular resistance index
文章编号： 中图分类号：R563 文献标志码：A
基金项目:河北省2023年度医学科学研究课题（20230723）
附件
| Author Name | Affiliation |
| LIU Yajian，HU Zhuosi，CAO Xuexia，ZHAO Lianlian，LIU Junjuan，QIN Yanjun | Department of Emergency Medicine,Hebei Medical University Third Hospital,Shijiazhuang,Hebei 050051,China |
引用文本：
刘雅建，胡卓思，曹雪霞，赵莲莲，刘俊娟，秦延军.血清SP-D、CCL25及肺血管阻力指数对创伤性湿肺肺损伤程度及预后的评估价值[J].中国临床研究,2025,38(8):1187-1191.
刘雅建，胡卓思，曹雪霞，赵莲莲，刘俊娟，秦延军.血清SP-D、CCL25及肺血管阻力指数对创伤性湿肺肺损伤程度及预后的评估价值[J].中国临床研究,2025,38(8):1187-1191.