Expression Of Heparin Binding Protein In Patients With Severe Post-Traumatic Acute Respiratory Distress Syndrome

Objective:To observe the expression of heparin binding protein(HBP)in patients with severe post-traumatic acute respiratory distress syndrome(ARDS),and to explore the clinical value of HBP in early diagnosis of severe post-traumatic ARDS.Methods:Prospective study methods were used to collect the patients admitted to the intensive care department of Yichun People's Hospital from January 1,2017 to December 31,2018 due to severe trauma(according to ISS >16 points).Basic vital signs,causes of severe trauma,blood routine,biochemical routine,blood gas analysis results and other data were collected.The plasma HBP level(once every 8 hours)was measured by enzyme-linked immunosorbent assay(ELISA)on day 1 and analyzed using the highest value in the first day.The PaO2/FiO2 of the patients in the first three days was detected.Patients with ARDS on day 1 after admission were excluded.Thirty patients who did not show ARDS in the first three days of admission were in the non-ARDS group.Twenty patients who showed mild to moderate ARDS on the second and third days of admission were in the mild to moderate ARDS group,and twenty patients who showed severe ARDS on the second and third days were in the severe ARDS group.The diagnostic and grading criteria for ARDS are based on the Berlin definition published at the 2012 annual meeting of the European society of critical care medicine.Spss19.0 was used to process the experimental data,compare the mild to moderate ARDS group,severe ARDS group and non-ARDS group,draw the ROC curve,calculate the area under the curve and determine the optimal cutoff value,and calculate the sensitivity and specificity of HBP by the optimal cutoff value.All the results were considered statistically significant with P < 0.05.Results:In this study,the HBP expression level in plasma of non-ards patients was(8.56±2.01)ng/ml,that of mild and moderate ARDS patients was(11.43±3.51)ng/ml,and that of severe ARDS patients was(14.50±3.63)ng/ml.Compared with non-ARDS patients,the plasma HBP levels of mild to moderate ARDS group and severe ARDS group were increased.The comparison of non-ards group,mild to moderate ARDS group and severe ARDS group was statistically significant(P<0.05).After ROC curve analysis,the HBP area under the curve was 0.782 for early diagnosis of mild and moderate ARDS after severe trauma.When the optimal HBP value was obtained,the plasma expression level was 9.14ng/ml,the sensitivity was 75.0%,and the specificity was 70.0%.In the early diagnosis of severe post-traumatic ARDS,the HBP area under the curve was 0.937,and when the optimal HBP value was taken,the plasma expression level was 12.62ng/ml,the sensitivity was 80.0%,and the specificity was 96.7%.There was no statistical significance in the comparison of PaO2/FiO2 between the three groups on the first day after severe trauma(P>0.05),while there was statistical significance in the comparison of PaO2/FiO2 between the three groups on the second and third days(P<0.01).Conclusion:After severe trauma,the plasma HBP level of ARDS patients was earlier than that of PaO2/FiO2,and the increased level was correlated with the severity of the disease.HBP can have some clinical reference value in the early diagnosis of ARDS after severe trauma.