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投稿时间：2025-06-18 网络发布日期：2025-08-20
投稿时间：2025-06-18 网络发布日期：2025-08-20
中文摘要: 目的 探究急性大出血输血相关急性肺损伤（TRALI）患者血清白细胞介素-33（IL-33）、血管性血友病因子（vWF）、粒细胞集落刺激因子（G-CSF）水平对其预后的预测价值。方法 选择2022年6月至2024年12月长安医院收治的急性大出血患者270例，将合并TRALI患者98例纳入TRALI组，将单纯急性大出血患者172例纳入非TRALI组。通过ELISA试剂盒检测血清IL-33、vWF、G-CSF水平；根据TRALI患者输血10 d后生存死亡情况分为预后不良组（死亡，31例）、预后良好组（存活，67例）。采用多因素logistic回归分析影响TRALI患者预后的因素。采用受试者工作特征曲线（ROC）分析血清IL-33、vWF、G-CSF水平对TRALI患者预后的预测价值。结果 TRALI组与预后不良组患者输血史、过敏史、发血至输血间隔≥0.5 h、输血次数>2次占比，以及血清IL-33、vWF、G-CSF水平分别高于非TRALI组与预后良好组（P<0.05）。输血史［OR=2.356，95%CI：1.329~4.176］、过敏史［OR=2.154，95%CI：1.383~3.354］、发血至输血间隔≥0.5h［OR=2.804，95%CI：1.387~5.667］、输血次数>2 次［OR=2.144，95%CI：1.065~4.316］、血清IL-33［OR=2.907，95%CI：1.571~5.379］、vWF［OR=2.942，95%CI：1.743~4.965］和G-CSF［OR=2.862，95%CI：1.556~5.265］水平是 TRALI 患者预后不良的独立影响因素（P<0.05）。血清 IL-33、vWF、G-CSF 水平单独预测 TRALI 预后的曲线下面积（AUC）（0.694，0.789，0.808）均小于三者联合预测（0.919）。结论 TRALI患者血清IL-33、vWF、G-CSF水平升高是影响其预后的风险因素，三者联合预测预后价值较高，可辅助TRALI的临床治疗与评估。
Abstract:Objective To explore the predictive value of serum interleukin-33（IL-33），von Willebrand factor（vWF），and granulocyte colony-stimulating factor（G-CSF）for the prognosis of acute massive hemorrhage patients withtransfusion-related acute lung injury（TRALI）. Methods From June 2022 to December 2024，270 patients with acute massive bleeding admitted to Chang'an Hospital were selected. Among them，98 patients with TRALI were labeled as the TRALI group，and 172 patients with simple acute massive bleeding were labeled as the non-TRALI group. ELISA kits were used to detect serum IL-33，vWF，and G-CSF. According to the survival and death status of TRALI patients after 10 days of blood transfusion，they were classified into the poor prognosis group（death，31 cases）and the good prognosis group（survival，67 cases）. Multivariate logistic regression model was used to explore the factors affecting the prognosis of TRALI patients. Receiver operating characteristic（ROC）was used to explore the predictive value of serum IL- 33， vWF，and G-CSF for the prognosis of TRALI. Results The proportions of transfusion history，allergy history，interval of blood sending to transfusion ≥ 0.5 h，transfusion frequency >2 times，and the levels of serum IL-33，vWF，and G-CSF in the TRALI group and poor prognosis group were higher than those in the non-TRALI group and good prognosis group，respectively（P<0.05）. The transfusion history［OR=2.356，95%CI：1.329-4.176］，allergy history［OR=2.154，95%CI：1.383-3.354］，interral of blood sending to transfusion ≥0.5 hours［OR=2.804, 95%CI：1.387-5.667］，number of transfusions >2［OR=2.144，95%CI：1.065-4.316］，serum IL-33 levels［OR=2.907, 95%CI：1.571-5.379］，vWF levels［OR=2.942，95%CI：1.743-4.965］，and G-CSF levels［OR=2.862，95%CI：1.556-5.265］were the factors affecting prognosis in TRALI patients（P<0.05）. The area under the ROC curve of serum IL-33，vWF，and G-CSF alone（0.694，0.789，0.808）in predicting TRALI prognosis were smaller than the combined prediction of the three indicators（0.919）. Conclusion Elevated levels of serum IL-33，vWF，and G-CSF in TRALI patients are risk factors affecting their prognosis. The combination of the three has high prognostic value and can assist in the clinical treatment and evaluation of TRALI.
keywords: Acute massive hemorrhage Transfusion-related acute lung injury Interleukin-33 von Willebrand factor Granulocyte colony-stimulating factor Prognosis
文章编号： 中图分类号：R457.1+3 文献标志码：A
基金项目:渭南市科技计划项目（2022ZDYFJH-163）
附件
| 作者 | 单位 |
| 杜丹 | 1. 渭南市中心血站检验科, 陕西 渭南 714000 |
| 魏鸽 | 2. 长安医院输血科, 陕西 西安 710016 |
| 王凌雪 | 2. 长安医院输血科, 陕西 西安 710016 |
| 刘宏斌 | 3. 长安医院呼吸内科, 陕西 西安 710016 |
| Author Name | Affiliation |
| DU Dan*，WEI Ge，WANG Lingxue，LIU Hongbin | *Department of Laboratory,Weinan Central Blood Station,Weinan,Shaanxi 714000,China |
| WEI Ge | |
| WANG Lingxue | |
| LIU Hongbin |
引用文本：
杜丹,魏鸽,王凌雪,等.血清IL-33、vWF、G-CSF水平与急性大出血输血相关性急性肺损伤患者预后的关系[J].中国临床研究,2025,38(8):1202-1206.
杜丹,魏鸽,王凌雪,等.血清IL-33、vWF、G-CSF水平与急性大出血输血相关性急性肺损伤患者预后的关系[J].中国临床研究,2025,38(8):1202-1206.