血浆可溶性尿激酶型纤溶酶原激活物受体对严重创伤后多器官功能障碍综合征的预测价值

赵胤杰; 李杨; 沈亚静; 桂永清; 张军; 张元松; 刘明华; 向强

doi:10.16016/j.1000-5404.202101075

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血浆可溶性尿激酶型纤溶酶原激活物受体对严重创伤后多器官功能障碍综合征的预测价值

临床医学 | 更新时间：2026-01-09

- 血浆可溶性尿激酶型纤溶酶原激活物受体对严重创伤后多器官功能障碍综合征的预测价值
- Predictive value of plasma soluble urokinase-type plasminogen activator receptor for post-severe traumatic multiple organ dysfunction syndrome
- 第三军医大学学报 2021年43卷第8期页码：730-735
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院急救部
- 作者简介：
  
  [向强，E-mail: xqiang163@163.com XIANG Qiang, E-mail: xqiang163@163.com
- 基金信息：
  
  重庆市技术创新与应用发展专项面上项目(cstc2019jscx-msxmX0222);陆军军医大学科技创新能力提升专项项目(2019XLC3001)
- DOI：10.16016/j.1000-5404.202101075
  中图分类号： R442.8;R446.112;R641
- 收稿：2021-01-08，
  
  修回：2021-02-03，
  
  纸质出版：2021-04-30
- 稿件说明：
移动端阅览
赵胤杰, 李杨, 沈亚静, 等. 血浆可溶性尿激酶型纤溶酶原激活物受体对严重创伤后多器官功能障碍综合征的预测价值[J]. 第三军医大学学报, 2021,43(8):730-735.

Yinjie ZHAO, Yang LI, Yajing SHEN, et al. Predictive value of plasma soluble urokinase-type plasminogen activator receptor for post-severe traumatic multiple organ dysfunction syndrome[J]. Journal of Third Military Medical University, 2021, 43(8): 730-735.
赵胤杰, 李杨, 沈亚静, 等. 血浆可溶性尿激酶型纤溶酶原激活物受体对严重创伤后多器官功能障碍综合征的预测价值[J]. 第三军医大学学报, 2021,43(8):730-735. DOI： 10.16016/j.1000-5404.202101075.

Yinjie ZHAO, Yang LI, Yajing SHEN, et al. Predictive value of plasma soluble urokinase-type plasminogen activator receptor for post-severe traumatic multiple organ dysfunction syndrome[J]. Journal of Third Military Medical University, 2021, 43(8): 730-735. DOI： 10.16016/j.1000-5404.202101075.

摘要

目的

探讨血浆可溶性尿激酶型纤溶酶原激活物受体(soluble urokinase-type plasminogen activator receptor，suPAR)对严重创伤后多器官功能障碍综合征(multiple organ dysfunction syndrome，MODS)的预测价值。

方法

纳入2019年12月至2020年12月我院创伤中心收治的108例严重创伤患者，入院采集静脉血并利用ELISA法检测血浆suPAR浓度，同时收集人口学资料及临床数据，根据住院14 d内的序贯器官衰竭评分(sequential organ failure assessment

SOFA)将患者分为MODS组和非MODS组。比较两组一般资料及suPAR、白细胞计数(WBC)、损伤严重度评分(injury severity score

ISS)等指标，采用Logistic回归分析筛选创伤后MODS的独立预测因素，ROC曲线评估各指标的预测价值。

结果

MODS组患者的年龄、合并慢性疾病率、ISS、入院suPAR、合并休克率、并发感染率和接受手术率均显著高于非MODS组[(52.6±14.1)岁

(46.1±14.1)岁

29.4%

9.5%

29 (25

33)分

26 (21

30) 分

(6.7±2.7) ng/mL

(5.0±2.1)ng/mL

41.2%

17.6%

61.8%

24.3%

52.9%

32.4%

0.05

]

，两组的性别、致伤因素、损伤部位、WBC和接受血液净化率差异无统计学意义。多因素Logistic回归分析显示，合并慢性疾病、ISS、suPAR及并发感染是创伤后发生MODS的独立预测因素(

0.05)。ROC曲线分析显示suPAR预测创伤后MODS的曲线下面积(AUC)为0.704(

0.05)，取截断值5.04 ng/mL时敏感度为73.5%，特异度为62.2%；ISS的AUC为0.632(

0.05)，取截断值26分时对应的敏感度为73.5%，特异度为58.1%。

结论

严重创伤患者入院血浆suPAR水平能够预测创伤后MODS的发生，早期监测suPAR对识别患者机体炎症及免疫激活水平、指导临床评估和治疗具有一定价值。

Abstract

Objective

To investigate the predictive value of plasma soluble urokinase-type plasminogen activator receptor (suPAR) for post-severe traumatic multiple organ dysfunction syndrome (MODS).

Methods

A total of 108 patients suffering from severe trauma admitted to the Trauma Center of our hospital from December 2019 to December 2020 were enrolled. Venous blood samples were collected at admission and plasma suPAR concentration was measured by ELISA

and their demographic and clinical data were collected. The patients were divided into MODS group and non-MODS group according to the sequential organ failure assessment(SOFA) within 14 d after admission. The general data and variables such as suPAR

white blood cell (WBC) count

and injury severity score (ISS) were compared between the 2 groups. Logistic regression analysis was used to screen the independent predictors for post-traumatic MODS

and receiver operating characteristic (ROC) curve was adopted to evaluate the predictive value of the variables.

Results

Age

rate of comorbidity

ISS

suPAR at admission

rate of shock

rate of infection and rate of surgery were significantly higher in the MODS group than the non-MODS group [52.6±14.1

46.1±14.1 years old

29.4%

9.5%

29 (25

33)

26 (21

30) points

6.7±2.7

5.0±2.1 ng/mL

41.2%

17.6%

61.8%

24.3%

52.9%

32.4%

0.05

]

. There were no significant differences in sex

injury cause

injury site

WBC count

and rate of blood purification between the 2 groups. Multivariate Logistic regression analysis showed that comorbidity

ISS

suPAR

and infection were independent predictors for post-traumatic MODS (

0.05). ROC curve analysis indicated that the area under the curve (AUC) of suPAR for predicting post-traumatic MODS was 0.704 (

0.05). When the cutoff value was 5.04 ng/mL

the sensitivity was 73.5% and the specificity was 62.2%. The AUC of ISS was 0.632 (

0.05)

and the sensitivity was 73.5% and the specificity was 58.1% when the cutoff value was 26.

Conclusion

The plasma suPAR level at admission can predict the occurrence of post-traumatic MODS in patients with severe trauma. Early monitoring of suPAR has a certain value in evaluation of inflammation and immune activation in the body and in guidance of clinical evaluation and treatment.

关键词

Keywords

references

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