sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情转归关系探究

目的 探讨可溶性白细胞分化抗原14（soluble cluster of differentiation antigen 14，sCD14）、血管生成素2（angiopoietin 2，Ang2）、C反应蛋白（C-reactive protein，CRP）与急诊创伤骨折伴多发伤患者病情转归的关系及意义。 方法 选取创伤骨折伴多发伤患者324例，根据患者出院时病情转归情况分为良好组（275例）、不良组（49例），比较2组一般资料、sCD14、Ang2、CRP水平，应用Pearson分析sCD14、Ang2、CRP与损伤严重程度评分（injury severity score，ISS）关系，采用Cox回归分析急诊创伤骨折伴多发伤患者病情转归的相关影响因素，采用受试者工作特征曲线（receiver operating characteristic，ROC）分析sCD14、Ang2、CRP对病情转归预测价值。 结果 不良组ISS评分高于良好组（P＜0.05）；不良组sCD14、Ang2、CRP高于良好组（P＜0.05）；sCD14（r=0.785）、Ang2（r=0.778）、CRP（r=0.842）与ISS评分呈正相关（P＜0.05）；sCD14、Ang2、CRP均是预后相关独立危险因素（P＜0.05）；sCD14、Ang2、CRP预测病情转归的ROC下面积（area under the curve，AUC）依次为0.813、0.757、0.749；挑选出预测敏感度最高（sCD14）、特异度最高（Ang2）的两个指标进行sCD14+Ang2的联合ROC分析显示，两者联合预测病情转归的AUC为0.935，大于任一单一指标（P＜0.05）。 结论 sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情严重程度及病情转归有关，均可作为预测病情转归的标志物，但联合检测sCD14、Ang2能提高预测可靠性，为临床诊疗及护理提供更准确的参考信息。

The relationship between sCD14, Ang2, CRP and the prognosis of emergency traumatic fracture patients with multiple injuries

Objective To investigate the relationship of soluble cluster of differentiation antigen 14 (sCD14), angiopoietin 2 (Ang2), and C-reactive protein (CRP) with the prognosis of emergency traumatic fracture patients with multiple injuries and their significance.Methods A total of 324 patients with traumatic fractures and multiple injuries were selected and divided into the good outcome group (n=275) and the poor outcome group (n=49) according to their disease outcomes at the time of discharge. The general data and the levels of sCD14, Ang2, and CRP were compared between two groups. The relationship between sCD14, Ang2, and CRP and the injury severity score (ISS) was analyzed by Pearson analysis. Cox regression analysis was used to analyze the relevant factors affecting the prognosis of patients with emergency traumatic fracture and multiple injuries. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of sCD14, Ang2 and CRP for disease outcome.Results The ISS score of the poor outcome group was higher than that of the good outcome group (P＜0.05). The sCD14, Ang2 and CRP in the poor outcome group were higher than those in the good outcome group (P＜0.05). sCD14 (r=0.785), Ang2 (r=0.778), and CRP (r=0.842) were positively correlated with ISS score (P＜0.05), and sCD14, Ang2 and CRP were all independent risk factors related to prognosis (P＜0.05). The area under ROC (AUC) of sCD14, Ang2, and CRP for predicting disease outcome was 0.813, 0.757, and 0.749, respectively. The two indicators with the highest predictive sensitivity (sCD14) and the highest specificity (Ang2) were selected for ROC analysis of the combination of sCD14+Ang2, showing that the AUC of the two combined in predicting disease outcome was 0.935, which was greater than any single index (P＜0.05).Conclusion sCD14, Ang2 and CRP are related to the severity and prognosis of emergency traumatic fracture patients with multiple injuries, and can be used as markers for predicting the prognosis of the disease. However, the combined detection of sCD14 and Ang2 can improve the prediction reliability and provide more accurate reference information for clinical diagnosis and treatment.