肺内源性和肺外源性急性呼吸窘迫综合征患者生物标志物水平变化的比较  

Serial changes in biomarkers in pulmonary and extrapulmonary acute respiratory distress syndrome

作　　者：杨卿 颜春松[2] 王亚飞 李雪英 张卫明[1] 肖阳 高山[1] 胡轶[1] Yang Qing;Yan Chunsong;Wang Yafei;Li Xueying;Zhang Weiming;Xiao Yang;Gao Shan;Hu Yi(Department of Respiratory and Critical Care Medicine,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China;Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院呼吸与危重症医学科,武汉430000 [2]南昌大学第二附属医院呼吸与危重症医学科,南昌330006

出　　处：《中华医学杂志》2019年第36期2816-2819,共4页National Medical Journal of China

摘　　要：目的比较肺内源性和肺外源性急性呼吸窘迫综合征(ARDS)患者生物标志物水平的变化.方法选取2017年4月至2018年2月期间在武汉市心医院呼吸重症监护病房(RCU)和重症医学科(ICU)住院且符合纳入标准的ARDS患者共36例,按照原发病因将其分为肺内源性组(20例)和肺外源性组(16例),测定两组诊断成立后第1、4、7天外周血清中血管生成素-2(Ang-2)、肺泡表面活性物质相关蛋白D(SP-D)及可溶性晚期糖基化终末产物受体(sRAGE)的水平,并进行比较分析.结果肺外源性组患者血清Ang-2水平呈逐渐下降趋势,第1天血清Ang-2水平显著高于第7天[2 801(1 386,7 526)比1 461(737,2 135)ng/L,P<0.05];肺内源性组患者第1、4、7天血清Ang-2水平差异均无统计学意义[1 462(545,3715)比1 353(659,5 847)比1 616(754,3 460)ng/L,均P>0.05].两组患者第1、4、7天血清SP-D水平差异均无统计学意义[肺内源性组:5.6(1.8,14.0)比5.7(1.8,14.5)比7.9(3.0,16.8)mg/L,均P>0.05;肺外源性组:3.4(0.5,9.1)比1.6(0.6,6.3)比1.6(0.7,7.9)mg/L,均P>0.05)].两组患者血清sRAGE水平均呈逐渐下降趋势,第1天血清sRAGE水平均显著高于第7天[肺内源性组:328(107,595)比66(50,171)ng/L,肺外源性组:237(98,410)比81(38,154)ng/L,均P<0.05].结论肺外源性ARDS患者外周血Ang-2水平在病程早期显著下降,而肺内源性ARDS患者外周血Ang-2水平在疾病早期无显著变化.Objective To compare the serial changes of circulating angiopoietin-2(Ang-2),surfactant protein D(SP-D)and soluble receptor for advanced glycation end product(sRAGE)in patients with pulmonary acute respiratory distress syndrome(ARDS)and extrapulmonary ARDS.Methods A total of 36 eligible patients with ARDS were included from the Department of Respiratory Intensive Care Unit(RCU)and Department of Intensive Care Unit(ICU),the Central Hospital of Wuhan,during April 2017 to February 2018,and divided into pulmonary ARDS group(n=20)and extrapulmonary ARDS group(n=16)according to primary causes.The levels of Ang-2,SP-D and sRAGE in serum of each group were measured on Day 1,4 and 7 after diagnosis.Results The serum level of Ang-2 in extrapulmonary ARDS group declined gradually during the course.The serum level of Ang-2 on Day 1 was significantly higher than that on Day 7[2 801(1 386,7 526)vs 1 461(737,2 135)ng/L,P<0.05].There was no significant difference in serum levels of Ang-2 on Day 1,4,7 in pulmonary ARDS group[1 462(545,3 715)vs 1 353(659,5 847)vs1 616(754,3 460)ng/L,all P>0.05].There was no significant difference in serum levels of SP-D on Day 1,4,7 in each group[pulmonary ARDS group:5.6(1.8,14.0)vs 5.7(1.8,14.5)vs 7.9(3.0,16.8)mg/L,all P>0.05;extrapulmonary ARDS group:3.4(0.5,9.1)vs 1.6(0.6,6.3)vs 1.6(0.7,7.9)mg/L,all P>0.05].The serum level of sRAGE in each group declined gradually during the course.The serum level of sRAGE on Day 1 in each group was significantly higher than that on Day 7[pulmonary ARDS group:328(107,595)vs 66(50,171)ng/L,extrapulmonary ARDS group:237(98,410)vs 81(38,154)ng/L,all P<0.05].Conclusion The serum level of Ang-2 in extrapulmonary ARDS declines significantly in the early stage of disease,while there is no significant difference in that of pulmonary ARDS.

关 键 词：急性呼吸窘迫综合征 生物标志物 肺内源性 肺外源性 

分 类 号：R563.8[医药卫生—呼吸系统]