摘要
目的探讨脓毒症并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者血清血管内皮钙黏蛋白(vascular endothelial cadherine,VE-Cad)、血管生成素2(angiopoietin-2,Ang-2)水平变化,及其与预后的关系。方法选取脓毒症并发ARDS患者79例作为研究对象,按照动脉血氧分压(partial pressure of oxygen,PaO2)/吸入氧浓度(fraction of inspiration,FiO2)将患者分为轻度组28例、中度组30例、重度组21例,4周后按照预后情况分为存活组46例和死亡组33例。比较各组血清VE-Cad、Ang-2水平,采用Pearson分析VE-Cad与Ang-2的相关性,采用二元Logistic回归分析脓毒症并发ARDS患者预后的影响因素,并采用受试者工作特征(receiver operating characteristics,ROC)曲线分析VE-Cad、Ang-2对脓毒症并发ARDS患者预后的诊断价值。结果血清VE-Cad、Ang-2水平比较:轻度组<中度组<重度组,差异有统计学意义(P<0.05)。存活组VE-Cad、Ang-2水平明显低于死亡组(P<0.05)。经Pearson分析,VE-Cad与Ang-2呈正相关(r=0.632,P<0.001)。经二元Logistic回归分析,VE-Cad是影响脓毒症并发ARDS预后的独立影响因素(P<0.05)。ROC曲线分析得出,VE-Cad、Ang-2、二者联合诊断脓毒症并发ARDS预后的AUC分别为0.906、0.690、0.912,VE-Cad、二者联合的诊断价值均较高;二者联合、VE-Cad的AUC明显高于Ang-2(Z=3.266、3.071,P=0.001、0.002);在最佳临界值对应的敏感度、特异度分别为:VE-Cad为87.9%、84.8%,Ang-2为45.5%、89.1%,二者联合为84.8%、80.4%。结论脓毒症并发ARDS患者血清VE-Cad水平、Ang-2水平随着病情加重而升高,死亡患者VE-Cad、Ang-2水平较生存患者高,且VE-Cad、二者联合对脓毒症并发ARDS预后具有较高的诊断价值,其中VE-Cad联合Ang-2的诊断价值最高。
Objective To investigate the changes of serum vascular endothelial cadherin(VE-Cad)and angiopoietin-2(Ang-2)levels in patients with sepsis complicated by acute respiratory distress syndrome(ARDS)and their relationship with prognosis.Methods A total of 79 patients with sepsis complicated by ARDS diagnosed and treated in our hospital were selected as the research subjects.According to the oxygenation index(PaO2/FiO2),patients were divided into mild group(n=28),moderate group(n=30)and severe group(n=21);they were divided into survival group(n=46)and death group(n=46)according to prognosis after 4 weeks.The levels of VE-Cad and Ang-2 in each group were compared.Pearson correlation analysis was used to analyze the correlation between VE-Cad and Ang-2,and binary Logistic regression analysis was used to analyze the factors affecting the prognosis of patients with sepsis and ARDS.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of VE-Cad and Ang-2 in prognosis of septic patients with concurrent ARDS.Results Serum VE-Cad and Ang-2 levels were the lowest in mild group,followed by moderate group and severe group,and the difference was statistically significant(P<0.05).The levels of VE-Cad and Ang-2 in the survival group were significantly lower than those in the death group(P<0.05).After Pearson analysis,VE-Cad was positively correlated with Ang-2(r=0.632,P<0.001).Binary logistic regression analysis indicated VE-Cad as an independent influencing factor for the prognosis of sepsis complicated with ARDS(P<0.05).ROC curve analysis showed that the AUC of VE-Cad,Ang-2,and the combination diagnosis of sepsis and ARDS for the prediction of diagnosis were 0.906,0.690,and 0.912,respectively.The diagnostic value of VE-Cad and the combination diagnosis of the two was higher;both The AUC of combination diagnosis and VE-Cad was significantly higher than that of Ang-2(Z=3.266,3.071,P=0.001,0.002).The corresponding sensitivity and specificity of VE-Cad and Ang-2 with respect to the optimal cut-off values were 87.9%,84.8%vs.45.5%,89.1%,respectively,and those of the combination of the two were 84.8%and 80.4%,respectively.Conclusion Serum VE-Cad and Ang-2 levels in patients with sepsis complicated by ARDS increase with the aggravation of the disease.The VE-Cad and Ang-2 levels in dead patients are higher than those in surviving patients,and VE-Cad and the combination of the two have a higher diagnostic value for the prognosis of sepsis complicated by ARDS.Specifically,VE-Cad combined with Ang-2 has the highest diagnostic value.
作者
文军
张永军
陈群
谭勇平
WEN Jun;ZHANG Yong-jun;CHEN Qun;TAN Yong-ping(Department of Emergency, the First People′s Hospital of Chenzhou, Hunan Province, Chenzhou 423000, China)
出处
《河北医科大学学报》
CAS
2021年第4期376-379,385,共5页
Journal of Hebei Medical University
基金
湖南省自然科学基金(18JJ6047)。
