血清DcR3在急性呼吸窘迫综合征预后评估中的价值  

Predictive value of serum DcR3 in acute respiratory distress syndrome

作　　者：谢姿[1] 胡明冬[1] 王长征[1] 李琦[1] 

机构地区：[1]第三军医大学新桥医院呼吸科,重庆400037

出　　处：《重庆医科大学学报》2017年第12期1644-1648,共5页Journal of Chongqing Medical University

基　　金：军队十二五重点资助项目(编号:BWS12J035)

摘　　要：目的:探讨血清Dc R3(Decoy receptor 3)在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后评估中的价值。方法:采纳前瞻性巢式病例对照研究设计方案。观察42例急性呼吸窘迫综合征患者30 d预后,21例全因死亡患者纳入死亡组,21例存活患者纳入存活组。分析0~24 h血清Dc R3与ARDS病情严重程度、MODS、全因死亡的关系。结果:30天全因死亡率为50.0%。轻、中、重度ARDS死亡率分别为23.1%、60.9%、66.7%。轻、中、重度ARDS患者血清Dc R3浓度分别为1.8(1.3~2.9)ng/mL、2.4(1.2~4.8)ng/mL、4.0(2.9~5.5)ng/mL,P=0.048。死亡组与存活组血清Dc R3浓度分别为3.1(2.4~5.5)ng/mL、1.8(1.1~2.7)ng/mL,P=0.014。并发MODS与未并发MODS患者基线血清Dc R3浓度分别为3.6(2.4~5.5)ng/mL、1.8(1.1~2.9)ng/mL,P=0.011。Cox回归分析显示Dc R3≥2.7 ng/mL(HR=2.557,95%CI=1.016~6.432,P=0.046)、并发MODS(HR=4.667,95%CI=1.751~12.443,P=0.020)、氧合指数≤165 mm Hg(HR=2.737,95%CI=1.049~7.141,P=0.040)是ARDS患者30 d死亡的独立预后预测因子。结论:血清Dc R3浓度高低与ARDS病情严重程度相关。ARDS患者早期血清Dc R3浓度增高与发生MODS以及30 d全因死亡风险增高有关。Objective：To explore the predictive value of serum DcR3 in acute respiratory distress syndrome（ARDS）.Methods：A prospective nested case-control study was conducted and 42 acute respiratory distress syndrome patients were enrolled.Of which,there were 21 non survivors and 21 survivors.The Berlin definition was used as a diagnostic criteria.Sera DcR3 concentrations were tested.Cox regression was used to evaluate the predictive value.Results：Thirty day all-cause mortality was 50% and the mortality was 23.1% for those with mild ARDS,60.9% for those with moderate ARDS,and 66.7% for those with severe ARDS.Baseline sera DcR3 levels were higher in non survivors than survivors（P=0.014）.Sera DcR3 in mild,moderate and severe ARDS were 1.8（1.3 to 2.9）ng/mL,2.4（1.2 to 4.8）ng/mL,4.0（2.9 to 5.5）ng/mL,respectively,P=0.048.Sera DcR3 were higher in non survivors than in survivors[3.1（2.4 to 5.5）ng/mL vs.1.8（1.1 to 2.7）ng/mL,P=0.014].Baseline sera DcR3 in patients developed MODS were higher than those who did not develop MODS[3.6（2.4 to 5.5）ng/mL vs.1.8（1.1 to 2.9）ng/mL,P=0.011].Cox regression showed that sera DcR3≥2.7 ng/mL（HR=2.557,95%CI=1.016 to 6.432,P=0.046）,developing MODS（HR=4.667,95%CI=1.751 to 12.443,P=0.020） and PaO_2/FiO_2≤165 mm Hg（HR=2.737,95%CI=1.049 to 7.141,P=0.040）were independently associated with an elevated risk of 30 day allcause mortality.Conclusion：Serum DcR3 level is associated with ARDS severity.Patients with higher sera DcR3 were associated with an elevated risk of developing MODS and 30 day all-cause mortality.

关 键 词：急性呼吸窘迫综合征 DC R3 预后 多器官功能障碍综合征 

分 类 号：R856.5[医药卫生—航空、航天与航海医学]