关键词: 涎液化糖链抗原6, 输血相关性急性肺损伤, 诊断, 评估

Abstract: Objective To explore the value of serum Kerbs von den Lungren 6（KL-6）in diagnosis of transfusion-related acute lung injury（TRALI）.Methods Before transfusion,at the time of 6h after that in 95 patients with mechanical ventilation,at the time of clinical diagnosis of TRALI when TRALI occurred,the observations including such as plasma BNP levels,arterial blood gas analysis,bedside chest X-ray examination,ventilator parameters,Murray lung injury score,serum KL-6 levels detected by ELISA method were collected. 95 patients with mechanical ventilation were divided into TRALI group and non-TRALI group according to the criteria of transfusion-related acute lung injury. Compared to before transfusion,the changes of serum KL-6 levels were analyzed between the TRALI group and non-TRALI group. The relationship between serum KL-6 and Murray lung injury score,oxygenation index was analyzed. In addition,the diagnostic significance of serum KL-6 was evaluated using ROC curve for diagnosing TRALI.Results Before transfusion,there were no statistically significant differences in Murray lung injury score,plat pressure （Pplat）,peak pressure （Ppeak）,oxygenation index,serum KL-6 levels,and BNP levels between the TRALI group and the non-TRALI group,P>0.05. In non-TRALI group,serum KL-6,BNP,lung injury score,oxygenation index,Ppeak and Pplat before transfusion were not significantly different than that at the time of 6h after transfusion,P>0.05. In TRALI group,compared to before transfusion,serum KL-6 levels were significantly higher,Murray lung injury score were significantly higher,Ppeak and Pplat were significantly higher,oxygenation index is significantly lower,at the time of clinical diagnosis of TRALI and at the time of 6h after transfusion,P<0.05. Compared with non-TRALI group,at the time 6h after transfusion,Serum KL-6 levels was significantly higher,lung injury score was significantly higher,oxygen combination index was significantly lower,Ppeak and Ppat were significantly higher in TRALI group,P<0.05. Serum KL-6 level was positively correlated with lung injury score,the correlation coefficient was 0.811,P<0.001. Serum KL-6 level was negatively correlated with the oxygenation index,and the correlation coefficient was -0.680,P<0.001. ROC curve analysis showed that serumKL-6 level can be used for diagnosis of TRALI,and the area under the curve （AUC） was 0.966,P<0.001. The sensitivity and specificity were 85.0% and 97.4% respectively when the level of serum KL-6 was higher than 369U·mL-1.Conclusion Serum KL-6 is a serological marker for acute lung injury,which is helpful for the laboratory diagnosis and evaluation of severity in TRALI patient with mechanical ventilation.

Key words: Kerbs von den Lungren-6, Transfusion-related acute lung injury, Diagnose, Predictive value