摘要: |
目的:探讨重症肺炎(SCAP)患者的血清学标志物对后续进展为急性呼吸窘迫综合征(ARDS)的预测效能。
方法:回顾性选择2019年至2021年中山医院呼吸内科监护室收治的SCAP 53例,基于 2012年ARDS柏林诊断标准,根据患者入院7天内是否发生ARDS,分为ARDS组和非ARDS组。收集病史资料及人口学信息,比较临床评分、实验室检查及临床结局,ELISA法测定血清细胞因子。采用Logistic回归分析发生 ARDS 的独立危险因素;并绘制受试者工作特征曲线(ROC)确定各因子的预测界值。
结果:两组患者的APACHE II、SOFA评分、PCT、CRP、是否使用机械通气、28天死亡率无统计学差异。与非ARDS组比较,ARDS组血清IL-6、vWF、TNF-a、Ang2水平升高,而S1P、IL-10水平显著降低。Logistic回归分析显示,vWF (OR=0.017, P=0.01)、IL-6和氧合指数是发生ARDS的独立危险因素。vWF和IL-6预测ARDS的曲线下面积(AUC)为0.881、0.749,最佳截断值分别是296.1、32.35 μg/L。
结论: IL-6、vWF对早期识别ARDS具有临床应用价值。 |
关键词: 重症肺炎 急性呼吸窘迫综合征 细胞因子,炎症反应 |
DOI:10.12025/j.issn.1008-6358.2023.20230228 |
分类号: |
基金项目:国家自然科学基金项目(面上项目,重点项目,重大项目)(82000095、82130001),科技部国家重点研发计划 (2020YFC2003700) |
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Predictor of serum biomarkers in acute respiratory distress syndrome events in patients with severe community-acquired pneumonia |
Lijuan Hu
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Zhongshan Hospital, Fudan University
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Abstract: |
Objective
This study was aimed to evaluate the predictive values of the serum biomarkers for patients at risk of developing acute respiratory distress syndrome (ARDS) due to severe community-acquired pneumonia (SCAP).
Methods.
A total of 53 SCAP patients were recruited from Zhongshan Hospital from 2019 to August 2021. They were divided into ARDS group and non-ARDS group according to the Berlin definition. Demographic information from SCAP patients was collected including baseline clinical variables, laboratory data as well as outcome. Biomarker concentrations were measured. The receiver operating characteristics (ROC) curves were calculated to discriminate ARDS cases.
Results.
There were no significant differences between ARDS and non-ARDS groups with respect to APACHE II score, SOFA score, CRP, PCT, rates of mechanical ventilation and 28-day mortality. Serum levels of IL-6、vWF、TNF-a and Ang2 in ARDS group exhibited significantly elevated than those in non-ARDS group. Logistic analysis suggested that PO2/FiO2 ratio, vWF (OR=0.017, P=0.01) and IL-6 levels were independent risk factors for occurrence of ARDS following SCAP. In particular, vWF was the most predictive biomarker for distinguishing SCAP patients with or without ARDS with an AUC of 0.881 (cut-off value 296.1). The increased levels of IL-6 predicted ARDS events with an area under the curve of 0.749 (cut-off value 32.35 μg/L).
Conclusions. The altered levels of IL-6 and vWF may be useful biologic confirmation of possible ARDS, as well as potentially selecting patients into optimal clinical practice. |
Key words: Severe Community-Acquired Pneumonia Acute Respiratory Distress Syndrome Inflammatory response Cytokines |