广西医学

目的探讨血清未成熟血小板比率（IPF）、乳酸脱氢酶与白蛋白比值（LAR）、骨形态发生蛋白9（BMP9）水平联合急性生理学与慢性健康状况评估Ⅱ（APACHEⅡ）评分对严重创伤合并脓毒症患者预后的预测价值。方法选取117例严重创伤合并脓毒症患者作为研究对象，根据入院28 d的预后情况将患者分为生存组（n=79）与死亡组（n=38）。比较两组患者入院时血清IPF、LAR、BMP9水平及APACHEⅡ评分。采用多因素Logistic回归模型分析严重创伤合并脓毒症患者预后的影响因素，绘制受试者工作特征（ROC）曲线评估血清IPF、LAR、BMP9水平及APACHEⅡ评分单独及四者联合对严重创伤合并脓毒症患者预后的预测价值。结果多因素Logistic回归分析结果显示，血清IPF、LAR、BMP9水平及APACHEⅡ评分为严重创伤合并脓毒症患者死亡的影响因素（P<0.05）。ROC曲线分析结果显示，血清IPF、LAR、BMP9水平及APACHEⅡ评分单独及四者联合预测严重创伤合并脓毒症患者预后的曲线下面积分别为0.903、0.895、0.918、0.884和0.963，灵敏度分别为81.58%、73.68%、84.21%、71.05%和94.74%，特异度分别为92.41%、96.20%、94.94%、94.94%和97.47%，四者联合预测的曲线下面积更大（P<0.05）。结论血清IPF、LAR、BMP9水平及APACHEⅡ评分是严重创伤合并脓毒症患者预后的影响因素，四者均对患者的预后具有一定的预测效能，且四者联合的预测效能更佳。

Objective To investigate the predictive value of combined serum immature platelet fraction (IPF), lactate dehydrogenase⁃to⁃albumin ratio (LAR), bone morphogenetic protein 9 (BMP9) level with the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score for the prognosis of patients with severe trauma and concomitant sepsis. Methods A total of 117 patients with severe trauma and concomitant sepsis were selected as the study subjects. According to the 28⁃day prognosis from admission, patients were divided into survival group (n=79) or death group (n=38). Serum IPF, LAR, BMP9 level and APACHEⅡ score at admission were compared between the two groups. Multivariate Logistic regression model was adopted to analyze the influencing factors for prognosis in patients with severe trauma and concomitant sepsis. Receiver operating characteristic (ROC) curves were plotted to evaluate the value of serum IPF, LAR, BMP9 level and APACHEⅡ score for alone and jointly predicting prognosis of patients with severe trauma and concomitant sepsis. Results Multivariate Logistic regression analysis revealed that serum IPF, LAR, and BMP9 level, and APACHEⅡ score were influencing factors for mortality in patients with severe trauma and concomitant sepsis (P<0.05). ROC curve analysis results indicated that areas under the curve of serum IPF, LAR, BMP9 level, and APACHEⅡ score for alone and jointly predicting prognosis of patients with severe trauma and concomitant sepsis were 0.903, 0.895, 0.918, 0.884, and 0.963, respectively, the sensitivities were 81.58%, 73.68%, 84.21%, 71.05%, and 94.74%, respectively, and the specificities were 92.41%, 96.20%, 94.94%, 94.94%, and 97.47%, respectively. The combined prediction yielded a larger area under the curve (P<0.05). Conclusion Serum IPF, LAR, BMP9 level and APACHEⅡ score are influencing factors for the prognosis of patients with severe trauma and concomitant sepsis. Each has a certain predictive performance for patients' prognosis, and their combined use demonstrates superior predictive performance.