血浆角蛋白-14水平对急性呼吸窘迫综合征患者的临床指导意义  

The clinical guiding significance of plasma keratin - 14 levels in patients with acute respiratory distress syndrome

作　　者：邓欣雨[1] 赵燕[1] 夏静[1] 杨艳利[1] 何婧[1] 王导新[1] 

机构地区：[1]重庆医科大学附属第二医院呼吸内科,重庆400010

出　　处：《中国急救医学》2016年第3期258-263,F0003,共7页Chinese Journal of Critical Care Medicine

摘　　要：[摘要]目的探讨血浆中角蛋白-14（KRT-14）表达水平对急性呼吸窘迫综合征（ARDS）患者的临床意义。方法采用前瞻性观察性临床研究方法，选择临床诊断的52例ARDS患者，以同期20例非ARDS患者为对照组。于患者入院后24h内记录急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和氧合指数（PaO2／FiO2），测定血KRT-14、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）水平，入院后第7天测定随机抽取的18例患者血浆KRT-14。结果与非ARDS组比较，ARDS组APACHE肼分和病死率增高，PaO2／FiO2降低，血浆各血清学指标水平升高。血浆KRT-14、IL-6、CRP随病情的加重升高。血浆KRT-14与PaO2／FiO2呈负相关（r=-0．548，P=0．00），入院24h内血浆KRT-14水平升高（OR=0．007，95％C10．000～0．319，P=0．011）是患者死亡的独立危险因素，死亡患者入院后的血浆KRT-14水平明显高于生存患者。KRT-14预测ARDS的ROC曲线下面积为0．97，在最佳临界值为3．52μg／L时，其特异度为90．0％，敏感度为96．2％。ARDS患者的血浆KRT-14水平高于普通肺炎患者及健康人。结论血浆KRT-14是肺损伤程度的重要标志物，可作为临床预测和评估ARDS的辅助指标。Objective To investigate the clinical signification of plasma keratin - 14 （ KRT - 14） levels in patients with acute respiratory distress syndrome （ARDS）. Methods A prospective investigation was conducted. Fifty - two ARDS patients were enrolled while twenty non - ARDS patients were served as control. The acute physiology and chronic health evaluation II （APACHEII） score, oxygenation index （PaO2/FiO2） were recorded, and the plasma levels of KRT - 14, tumor necrosis factor （TNF - α）, interleukin - 6 （ IL - 6）, proealeitonin （ PCT）, C - reaction protein （CRP） were measured within 24 hours after admission. There were 18 patients randomly selected from the ARDS group who were measured plasma KRT - 14 levels again at the 7th day of hospitalization. The independent risk factors of ARDS were analyzed by univariate and muhivariable Logistic regression. Receiver operating characteristic curve （ROC） was plotted to evaluate the value of KRT - 14 in predicting ARDS patients. T - test was used for explaining the different plasma KRT - 14 levels between the deaths and the survivors after them admitting to the hospital. This analysis also used to compare the KRT - 14 levels between the healthy control group and the ARDS patients group. It also explained the difference between the pneumonia group and the pneumonia induced ARDS group. Results Compared with non -ARDS group, APACHE I1 score and mortality were increased while PaO2/FiO2 was decreased. And levels of the plasma biomarkers we measured were all elevated. KRT - 14, IL - 6 and CRP were increased with the aggravation of the disease. The plasma KRT - 14 levels was significantly negatively correlated with PaO2/FiO2 （ r = - 0.548, P = 0.00）. Increased plasma KRT - 14 levels within 24 hours （OR = 0. 007,95% CI 0. 000 -0. 319, P = 0. 011 ） after admission were the independent prognostic factors for the 28 - day mortality in ARDS, and KRT - 14 levels of the deaths were obviously higher than those of the survivors. The area under the RO

关 键 词：急性呼吸窘迫综合征(ARDS) 角蛋白-14(KRT-14) 诊断 预后 

分 类 号：R563.8[医药卫生—呼吸系统]