血清ACSL4、sLOX-1、RETN在创伤合并脓毒症患者早期诊断和预后评估中的价值OA
Analysis of the value of serum ACSL4,sLOX-1,and RETN as potential biomarkers for early diagnosis and prognosis of trauma complicated with sepsis
目的 探讨血清长链酰基辅酶 A 合成酶 4(ACSL4)、可溶性凝集素样氧化低密度脂蛋白受体 1(sLOX-1)、抵抗素(RETN)作为创伤合并脓毒症(TS)早期诊断和预后潜在生物标志物的价值分析.方法 选取 2023年 2 月—2026 年 2 月西安交通大学第一附属医院急诊科诊治的 TS 患者 138 例作为 TS 组,单纯创伤患者 120 例为Con 组,根据随访 28 d 预后生存状况将 TS 组分为死亡亚组 45 例和存活亚组 93 例.采用 ELISA 法检测血清 ACSL4、sLOX-1、RETN 水平;多因素 Logistic 回归分析 TS 患者预后死亡的影响因素;ROC 曲线分析血清 ACSL4、sLOX-1、RETN水平对 TS 患者预后不良的预测效能;采用 Bootstrap 自举法系统校验模型内在稳定性.结果 TS 组血清 ACSL4、sLOX-1、RETN 水平高于 Con 组(t/P=7.758/＜0.001、7.945/＜0.001、9.750/＜0.001);与存活亚组比较,死亡亚组患者休克占比及血清 ACSL4、sLOX-1、RETN 水平升高(χ2/P=8.474/0.004,t/P=7.504/＜0.001、7.350/＜0.001、7.149/＜0.001).多因素 Logistic 回归分析结果显示,休克、ACSL4高、sLOX-1高、RETN 高为 TS 患者预后死亡的危险因素[OR(95%CI)=3.286(1.426～7.573)、3.575(1.891～6.760)、2.983(1.647～5.402)、6.883(3.052～15.525)];血清 ACSL4、sLOX-1、RETN水平单独及三者联合预测 TS 患者预后不良的 AUC 分别为 0.801、0.763、0.869、0.935,三者联合优于各自单独预测效能(Z/P=3.144/0.002、4.128/＜0.001、2.360/0.018);H-L 拟合优度检验评估模型校准度显示,模型预测曲线与实际数据点一致性较高(χ2/P=8.206/0.414).结论 TS 患者血清 ACSL4、sLOX-1、RETN 水平均升高,三者联合检测对 TS 患者预后不良的预测效能较好.
Objective To explore the value of serum long-chain acyl-CoA synthetase 4(ACSL4),soluble lectin-like oxidized low-density lipoprotein receptor 1(sLOX-1),and resistin(RETN)as potential biomarkers for the early diagnosis and prognosis of trauma complicated with sepsis(TS).Methods A total of 138 patients with TS treated in the Emergency De-partment of the First Affiliated Hospital of Xi'an Jiaotong University from February 2023 to February 2026 were selected as the TS group,and 120 patients with isolated trauma were selected as the control group.The TS group was further divided into a death subgroup(n=45)and a survival subgroup(n=93)based on 28-day follow-up outcomes.Serum levels of ACSL4,sLOX-1,and RETN were detected by ELISA.Factors influencing the prognosis of TS patients were analyzed.ROC curve analysis was used to evaluate the early diagnostic value of serum ACSL4,sLOX-1,and RETN for TS and their predictive effi-ciency for prognosis.In addition,the Bootstrap resampling method was employed to systematically validate the internal stabili-ty of the model.Results Compared with the control group,serum levels of ACSL4,sLOX-1,and RETN were significantly higher in the TS group(t=7.758,7.945,9.750;all P<0.001).Compared with the survival subgroup,the death subgroup had a significantly higher shock rate and significantly elevated serum levels of ACSL4,sLOX-1,and RETN(χ2/t=8.474,7.504,7.350,7.149;P=0.004,<0.001,<0.001,<0.001).Shock,high serum ACSL4,high sLOX-1,and high RETN were independent prognostic factors for TS patients[OR(95%CI)=3.286(1.426-7.573),3.575(1.891-6.760),2.983(1.647-5.402),6.883(3.052-15.525)].The AUCs of serum ACSL4,sLOX-1,RETN,and their combination for predicting poor prognosis in TS pa-tients were 0.801,0.763,0.869,and 0.935,respectively.The combined use of these three markers significantly outperformed individual predictions(Z=3.144,4.128,2.360;P=0.002,<0.001,0.018).Internal validation showed that the model's prediction curve was highly consistent with the actual observed data.Conclusion Serum levels of ACSL4,sLOX-1,and RETN are elevated in patients with TS.Combined detection of these three markers demonstrates superior diagnostic and prog-nostic efficiency for TS.
郝琳;李敏玲;周铜;孙阿巧
710061 西安,西安交通大学第一附属医院急诊科710061 西安,西安交通大学第一附属医院急诊科710077 西安,西电集团医院急诊科710061 西安,西安交通大学第一附属医院急诊科
医药卫生
创伤脓毒症长链酰基辅酶A合成酶4可溶性凝集素样氧化低密度脂蛋白受体1抵抗素诊断预后
TraumaSepsisLong-chain acyl-CoA synthetase 4Soluble lectin-like oxidized low-density lipoprotein receptor 1ResistinDiagnosisPrognosis
《疑难病杂志》 2026 (9)
1043-1048,6
陕西省重点研发计划项目(2022ZDZM-SF-001) Key Research and Development Project of Shaanxi Province(2022ZDZM-SF-001)
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