血浆vWF:Ag、蛋白C活性在ALI/ARDS患者诊断和预后中的意义  被引量:6

Evaluation of Plasma vWF:Ag and Protein C Activity in the Diagnosis and Prognosis of Patients at Risk of ALI/ARDS

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作  者:夏炎火[1] 林锡芳[1] 潘景业[1] 王丹[1] 李卓英[1] 杨梅[1] 

机构地区:[1]温州医学院附属第一医院ICU,325000

出  处:《医学研究杂志》2013年第3期89-93,共5页Journal of Medical Research

基  金:温州市科技局基金资助项目(Y20110167)

摘  要:目的探讨血浆血管性血友病因子抗原(vWF:Ag)、蛋白C(PC)活性在急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者早期诊断和预后判断中意义。方法对49例ALI/ARDS患者和21例非ALI/ARDS患者分别测定血浆vWF:Ag和PC活性,并进行急性生理及慢性健康状况(APACHE)Ⅱ评分和肺损伤评分(LIS),进一步将ALI/ARDS患者按预后、病因和器官衰竭数目(除肺外)分组,计算病死率,对结果进行比较。利用受试者工作特征(ROC)曲线评价vWF:Ag和PC活性的诊断分辨度。结果与非ALI/ARDS组相比,ALI/ARDS组病死率和LIS评分明显升高,PaO2/FiO2明显降低,ALI/ARDS组患者血浆vWF:Ag(104%~752%)明显增高(P=0.026),而PC活性(14%~125%)明显降低(P=0.002)。ALI/ARDS患者中死亡组、感染组和≥2个器官功能衰竭组血浆vWF:Ag明显高于对照组,而PC活性明显低于对照组,感染组和≥2个器官功能衰竭组病死率明显高于对照组。PC活性对预测ALI/ARD准确性较好(AUC=0.709,95%CI:0.588~0.811,P=0.002),PC活性≤83%时,预测ALI/ARDS的敏感度和特异性分别为77.75%和57.14%,而vWF:Ag在预测ALI/ARDS准确性较差(AUC=0.584,95%CI:0.460~0.701,P=0.243)。结论 血浆vWF:Ag升高和PC活性降低对判断ALI/ARDS预后都有重要作用,血浆vWF:Ag越高,PC活性越低则预后越差;但在预测ALI/ARDS上有差异,血浆PC活性预测ALI/ARDS的准确性较好,而血浆vWF:Ag预测ALI/ARDS的诊断价值有争议。Objective To evaluate the value and feasibility of plasma vWF:Ag and protein C activity in the diagnosis and prognosis in ALI/ARDS patients.Methods The clinical data of 49 ALI/ARDS patients and 21 non-ALI / ARDS patients was collected and evaluated with APACHE Ⅱ score system and lung injury score(LIS).Furthermore,ALI/ARDS patients were divided into two groups by prognosis,etiology,and organ failure number(nonpulmonary).Mortality of every group was collected.Plasma vWF:Ag and protein C activity of patients were detected and evaluated.The value of plasma vWF:Ag and protein C activity in diagnosis of ALI/ARDS was analyzed by receiver operator characteristic(ROC) curve.Results Compared with non-ALI/ARDS group,the mortality and LIS score of ALI/ARDS group were significantly increased,PaO2/FiO2 was significantly declined.Plasma vWF: Ag(104%-752%) in ALI / ARDS group was higher(P=0.026),but PC activity(14%-125%) was significantly lower(P=0.002).In the ALI/ARDS patients,plasma vWF: Ag of dead group,infected group and ≥ 2 organ failure group were significantly higher than their control group;while PC activity of the three groups were greatly lower than their control groups.ROC curve analysis showed that PC activity was better in prediction ALI/ARDS(AUC=0.709,95% CI:0.588-0.811,P=0.0016),and the sensitivity and specificity were respectively 77.75% and 57.14% when PC activity ≤83%;but vWF: Ag was poor in prediction ALI/ARDS(AUC=0.584,95% CI:0.460-0.701,P=0.2426).Conclusion Elevated plasma vWF:Ag and declined PC activity are associated with an increased risk of death and worse prognosis in ALI/ARDS patients.The accuracy of plasma PC activity to predict ALI/ARDS was better,but it is a controversial conclusion in prediction ALI/ARDS by plasma vWF:Ag.

关 键 词:ALI ARDS VWF Ag PC活性诊断预后 

分 类 号:R541.6[医药卫生—心血管疾病]

 

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