摘要
目的探讨脓毒症所致急性呼吸窘迫综合征(ARDS)患者血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、前B细胞克隆增强因子(PBEF)、血管内皮钙黏蛋白(VE-Cad)水平与病情和其他几项炎性反应指标的关系,分析影响脓毒症所致ARDS患者预后的危险因素。方法80例脓毒症所致ARDS患者纳入ARDS组,178例未发生ARDS的脓毒症患者纳入对照组,检测所有患者血清suPAR、PBEF、VE-Cad、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)水平,进行急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分。分析ARDS患者血清suPAR、PBEF、VE-Cad与APACHEⅡ评分、SOFA评分、CRP、PCT、IL-6的相关性。追踪ARDS组患者临床结局,对影响脓毒症所致ARDS患者预后的因素进行多因素Logistic回归分析。结果ARDS组APACHEⅡ评分、SOFA评分及血清suPAR、PBEF、VE-Cad、CRP、PCT、IL-6水平高于对照组,差异有统计学意义(P<0.05)。血清suPAR、PBEF、VE-Cad水平在轻度、中度、重度ARDS患者间依次升高,两两比较,差异有统计学意义(P<0.05)。ARDS组血清suPAR、PBEF、VE-Cad水平与APACHEⅡ评分、SOFA评分及CRP、PCT、IL-6水平均呈正相关(P<0.05)。ARDS组死亡31例,存活49例,死亡组血清suPAR、PBEF、VE-Cad水平高于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,ARDS分级(重度)、高APACHEⅡ评分及高水平CRP、PCT、suPAR、PBEF、VE-Cad是脓毒症所致ARDS患者不良预后的危险因素(P<0.05)。结论脓毒症所致ARDS患者血清suPAR、PBEF、VE-Cad水平升高,suPAR、PBEF、VE-Cad与病情严重程度、CRP、PCT、IL-6和预后有关,可为脓毒症所致ARDS患者预后评估提供参考。
Objective To investigate the relationship between serum soluble urokinase plasminogen activator receptor(suPAR),pre-B cell colony-enhancing factor(PBEF),vascular endothelial cadherine(VE-Cad)levels and disease status and other inflammatory indicators in patients with acute respiratory distress syndrome(ARDS)caused by sepsis,and to analyze the risk factors affecting the prognosis of patients with ARDS caused by sepsis.Methods A total of 80 sepsis patients with ARDS were recruited in ARDS group,and 178 sepsis patients without ARDS were recruited in control group.Serum suPAR,PBEF,VE-Cad,C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)levels were detected,and acute physiological and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score were evaluated.The correlations between serum suPAR,PBEF,VE-Cad and APACHEⅡ,SOFA,CRP,PCT,IL-6 in patients with ARDS were analyzed.To track the clinical outcome of patients with ARDS,Logistic regression analysis was conducted to analyze the risk factors affecting on prognosis of patients with ARDS caused by sepsis.Results The serum suPAR,PBEF,VE-Cad,CRP,PCT and IL-6 levels,APACHEⅡscore,SOFA score in ARDS group were higher than those in control group(P<0.05).The levels of serum suPAR,PBEF and VE-Cad increased successively among mild,moderate and severe ARDS patients(P<0.05).Serum suPAR,PBEF,VE-Cad levels in ARDS group positively correlated with APACHEⅡscore,SOFA score,CRP,PCT and IL-6 levels(P<0.05).In ARDS group,31 cases died,and 49 cases survived,serum suPAR,PBEF,VE-Cad levels in death group were higher than those in survival group(P<0.05).Logistic regression analysis showed that ARDS grade(severe),high APACHEⅡscore,high levels of CRP,PCT,suPAR,PBEF,VE-Cad were the risk factors of poor prognosis in patients with ARDS caused by sepsis(P<0.05).Conclusion Serum suPAR,PBEF and VE-Cad levels increased in patients with ARDS caused by sepsis.suPAR,PBEF and VE-Cad related to the severity of the disease status,CRP,PCT,IL-6 and prognosis,which could provide reference for the prognosis assessment of patients with ARDS caused by sepsis.
作者
吴莎莎
杨帅
沈超
王宗强
吴红栋
WU Shasha;YANG Shuai;SHEN Chao;WANG Zongqiang;WU Hongdong(Department of Emergency Medicine,Zhuhai People′s Hospital/Zhuhai Hospital Affiliated to Jinan University,Zhuhai,Guangdong 519000,China)
出处
《国际检验医学杂志》
CAS
2021年第10期1189-1194,共6页
International Journal of Laboratory Medicine
基金
2018年度广东省医学科研基金立项项目(A20183371)。
