摘要
目的:观察晚期糖基化终产物(RAGE)及其代谢产物可溶性晚期糖基化终末产物受体(sRAGE)水平对危重患者呼吸机相关性肺炎(VAP)预后的预测作用。方法:回顾性分析40例VAP患者的临床资料,根据患者28 d生存状况分为存活组(24例)和死亡组(16例)。采用实时荧光定量RT-PCR检测患者外周血单个核细胞(PMBC)中RAGE mRNA表达。采用酶联免疫吸附法检测患者血浆sRAGE和血清炎症因子白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平。采用受试者工作特征曲线(ROC)分析相关指标与VAP患者死亡的关系。结果:28 d病死率为40%(16/40)。与存活组比较,死亡组患者PMBC中RAGE mRNA及PCT、IL-6、TNF-α和sRAGE水平显著升高(P<0.01或P<0.05)。血浆中sRAGE水平ROC曲线下面积为0.779,最佳截点为2.59 ng/L,敏感度、特异度分别为81.3%、73.9%(P=0.003)。PMBC中RAGE mRNA的ROC曲线下面积为0.749,IL-6为0.872,TNF-α为0.720,PCT为0.879,CRP为0.310。结论:血浆sRAGE水平及PMBC中RAGE mRNA的升高与VAP患者的死亡密切相关。血浆sRAGE水平对预测VAP患者的预后具有一定的意义。
Objective:To observe the predictive effect of receptors for advanced glycation end products(RAGE)and their metabolites soluble receptors for advanced glycation end products(sRAGE)on critically ill patients with ventilator-associated pneumonia(VAP).Methods:The retrospective analysis was done on 40 cases of VAP.All the patients according to the 28-day survival were divided into two groups:survival group(24 cases)and death group(16 cases).The RAGE mRNA expression in human peripheral blood mononuclear cells(PMBC)was detected by real-time-PCR.ELISA method was used to detect the protein expression of sRAGE,IL-6,IL-8 and TNF-alpha in the plasma and serum of patients.Correlation between these indicators and mortality in VAP patients was analyzed by ROC curve.Results:The 28-day mortality in VAP patients was 40%(16/40).As compared with survival group,the RAGE mRNA,PCT,IL-6,TNF-αand sRAGE levels in death group were significantly increased(P<0.01 or P<0.05).The area under the ROC curve of the plasma sRAGE level was 0.779,and the best cut-off point was 2.59 ng/L.The sensitivity and specificity of the assay were 81.3%and 73.9%respectively(P=0.003).Under the other ROC curves,the area of PMBC RAGE mRNA,IL-6,TNF-α,PCT and CRP was0.749,0.872,0.720,0.879,and 0.310 respectively.Conclusions:The elevation of plasma sRAGE and PMBC RAGE mRNA is closely related to the death of VAP.The level of sRAGE in plasma has a certain significance in predicting the prognosis of VAP patients.
作者
唐瑾
张文
徐小妹
杨志龙
刘可心
王学斌
TANG Jin;ZHANG Wen;XU Xiao-mei;YANG Zhi-long;LIU Ke-xin;WANG Xue-bin(Ji'an Hospitai of Easi Hospital,Ji'an 343000,China)
出处
《内科急危重症杂志》
2021年第2期121-124,共4页
Journal of Critical Care In Internal Medicine
基金
吉市科计字[2018]6号(49)。
关键词
呼吸机相关性肺炎
炎症因子
晚期糖基化终产物受体
预后
Ventilator-associated pneumonia
Inflammatory cytokines
Receptors for advanced glycation end-products
Prognosis
