摘要
目的探讨血浆内皮细胞特异性分子-1(endothelial cell specific molecule-1, ESM-1)对脓毒症性急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)发生的预测价值。方法本研究共纳入符合脓毒症诊断标准患者54例,根据在72h内是否并发ARDS将患者分为非ARDS组(n=42例)与ARDS组(n=12例)。分别检测入组第1、2、3、7天患者血浆ESM-1、白细胞(white blood cell, WBC)、C反应蛋白(C-reactive protein, CRP)、白介素6(interleukin 6, IL-6)、降钙素原(procalcitonin, PCT)水平,并计算氧和指数(oxygenation index, OI)。结果入组第1天的ARDS组患者血浆ESM-1浓度水平明显低于非ARDS组(t=2.778,P=0.009)。血浆ESM-1浓度与OI相关性好。经Logistic回归分析,入组第1天的血浆ESM-1与CRP、IL-6为预测脓毒症患者ARDS发生的独立危险因素,ESM-1的AUC为0.750,cut-off为5.865ng/mL,CRP的AUC为0.736,IL-6的AUC为0.736。结论第1天的血浆ESM-1与CRP、IL-6为脓毒症患者ARDS发生的独立危险因素,血浆ESM-1作为脓毒症ARDS的预测标记物,有较好的价值。
Objective To assess the predictive value of plasma ESM-1 to acute respiratory distress syndrome(ARDS) in septic patients. Methods Fifty four patients with sepsis were enrolled in the study.Within 72 h after admission, ARDS occurred in 12 patients(ARDS group)and did not occur in 42 patients(non-ARDS group). Plasma ESM-1, WBC, CRP, IL-6 and PCT were measured on d1, d3 and d7 after admission, and the oxygenation index(OI) was calculated. Results Plasma ESM-1 level in ARDS group on d1 was significantly lower than that in non-ARDS group(t=2.778, P=0.009). Plasma ESM-1 level was negatively correlated OI at d2, d3 and d3(all P<0.05). Logistic regression analysis showed that plasma ESM-1, CRP and IL-6 levels on d1 were independent risk factors for ARDS in septic patients. The AUC of ESM-1 was 0.750(P=0.009), which was higher than that of CRP and IL-6. The cut-off value of ESM-1 for predicting ARDS was 5.865 ng/mL with a sensitivity of 0.786 and a specificity of 0.583. Conclusion The plasma ESM-1, CRP and IL-6 level on the 1 st day are associated with the occurrence of ARDS in septic patients, while ESM-1 is a better predictor for sepsis ARDS.
作者
叶海燕
王学斌
巨轩
刘杨
董婷
杨欢
YE Hai-yan;WANG Xue-bin;JU Xuan;LIU Yang;DONG Ting;YANG Hua(Intensive Care Unit,East Hospital,Tongji University School of Medicine,Shanghai 200120,China;Dept.of Emergency,Shanghai Pudong New Area People s Hospital,Shanghai 201200,China)
出处
《同济大学学报（医学版）》
CAS
2019年第6期853-858,共6页
Journal of Tongji University(Medical Science)
基金
上海市卫生和计划生育委员会科研课题(201440320)
上海市重中之重临床医学中心和重点学科建设项目(2017zz02017)
