【摘要】 目的 分析血清Toll样受体4(TLR4)、巨噬细胞炎性蛋白1-α(MIP-1α)、T细胞免疫球蛋白及黏蛋白域蛋白4(TIM-4)与重症颅脑损伤患者肺部感染发生及预后的关系,并探讨血清TLR4、MIP-1α、TIM-4水平对重症颅脑损伤患者肺部感染发生及预后的预测价值,以期为临床决策的制定提供参考。方法 选取2022年1月—2025年1月本院收治的182例重症颅脑损伤患者为研究对象。依据患者是否发生肺部感染分为感染组(n=75)和未感染组(n=107)。随后将肺部感染患者依据其预后情况分为预后良好组(n=43)和预后不良组(n=32)。入院后测定所有患者血清TLR4、MIP-1α、TIM-4水平,采用logistic回归分析血清TLR4、MIP-1 α、TIM-4水平与重症颅脑损伤患者肺部感染及预后的相关性;采用受试者特征工作(ROC)曲线评估血清TLR4、MIP-1α、TIM-4水平预测重症颅脑损伤患者肺部感染及预后的效能。结果 相比于未感染组,感染组患者的血清TLR4、MIP-1α、TIM-4水平明显升高(P<0.05)。存在肺部感染的患者中,相比于预后良好组,预后不良组患者的血清TLR4、MIP-1α、TIM-4水平明显升高(P<0.05)。logistic回归分析显示,血清TLR4(OR=1.497,95%CI:1.265～1.772)、MIP-1α(OR=1.080,95%CI:1.027～1.136)、TIM-4(OR=1.073,95%CI:1.041～1.106)水平升高是重症颅脑损伤患者肺部感染的独立危险因素。同时,血清TLR4(OR=2.191,95%CI:1.336～3.594)、MIP-1α(OR=1.324,95%CI:1.122～1.562)、TIM-4(OR=1.112,95%CI:1.029～1.201)水平升高是重症颅脑损伤肺部感染患者不良预后的独立危险因素。ROC曲线显示,血清TLR4、MIP-1α、TIM-4联合预测重症颅脑损伤患者肺部感染的曲线下面积(AUC)为0.843(95%CI:0.782～0.892),灵敏度为73.33%,特异度为87.85%,联合预测效能优于各指标单独预测(P<0.05);血清TLR4、MIP-1α、TIM-4联合预测肺部感染患者预后的AUC为0.880(95%CI:0.784～0.944),灵敏度为84.37%,特异度为83.72%,联合预测效能优于各指标单独预测(P<0.05)。结论 血清TLR4、MIP-1α、TIM-4水平与重症颅脑损伤患者肺部感染的发生及预后密切相关,三者联合测定可预测重症颅脑损伤患者肺部感染的发生及预后,为临床提供一定指导。更多还原

【Abstract】 Objective To analyze the relationships between serum Toll-like receptor 4(TLR4),macrophage inflammatory protein-1α(MIP-1α),and T-cell immunoglobulin,and mucin domain-containing protein 4(TIM-4) and the occurrence and prognosis of pulmonary infection in patients with severe traumatic brain injury(sTBI),and to evaluate the predictive value of these serum markers for pulmonary infection and prognosis in sTBI patients,aiming to provide a reference for clinical decision-making.Methods A total of 182 patients with sTBI admitted to our hospital from January 2022 to January 2025 were enrolled.According to whether pulmonary infection occurred,patients were assigned to an infection group(n=75) and a non-infection group(n=107).Patients with pulmonary infection were further classified by outcome into a good-prognosis group(n=43)and a poor-prognosis group(n=32).Serum TLR4,MIP-1α,and TIM-4 levels were measured on admission.Logistic regression analysis was used to analyze the associations of serum TLR4,MIP-1α,and TIM-4 with pulmonary infection and prognosis;receiver operating characteristic(ROC) curves were used to evaluate the predictive performance of these markers.Results Compared with the non-infection group,patients in the infection group had significantly higher TLR4,MIP-1α,and TIM-4levels(P <0.05).Among patients with pulmonary infection,those with poor prognosis had significantly higher TLR4,MIP-1α,and TIM-4 levels than those with good prognosis(P<0.05).Logistic regression analysis showed that elevated TLR4(OR=1.497,95% CI:1.265-1.772),MIP-1α(OR=1.080,95% CI:1.027-1.136) and TIM-4(OR=1.073,95% CI:1.041-1.106) were independent risk factors for pulmonary infection in sTBI patients;likewise,increased TLR4(OR=2.191,95% CI:1.336-3.594),MIP-1α(OR=1.324,95% CI:1.122-1.562) and TIM-4(OR=1.112,95% CI:1.029-1.201) were independent risk factors for poor prognosis among sTBI patients with pulmonary infection.ROC analysis demonstrated that the combined prediction model using TLR4,MIP-1α,and TIM-4 yielded an AUC of 0.843(95 % CI:0.782-0.892) for predicting pulmonary infection,with a sensitivity of 73.33% and specificity of 87.85%;the combined model outperformed each marker alone(P<0.05).For predicting prognosis among infected patients,the combined markers produced an AUC of 0.880(95% CI:0.784-0.944),with a sensitivity of 84.37% and specificity of 83.72%,again superior to individual markers,with significant differences(P<0.05).Conclusion TLR4,MIP-1α,and TIM-4 levels are closely correlated with both the occurrence of pulmonary infection and clinical outcomes in patients with sTBI.Joint measurement of these markers improves the prediction of pulmonary infection and prognosis and may provide useful guidance for clinical management.更多还原