循环微粒水平对急性呼吸窘迫综合征的预后价值  

Prognostic Value of Circulating Microparticle Level in Acute Respiratory Distress Syndrome

作　　者：葛文品[1] 戚迪[2] 王导新[2] 何婧[2] 赵燕[2] 邓旺[2] 朱涛[2] GE Wen-pin;QI Di;WANG Dao-xin;HE Jing;ZHAO Yan;DENG Wang;ZHU Tao(Chongqing Three Gorges Medical College,Chongqing 404120,China;Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆三峡医药高等专科学校,重庆404120 [2]重庆医科大学附属第二医院呼吸与危重症医学科,重庆400010

出　　处：《中国医药指南》2019年第25期1-3,6,共4页Guide of China Medicine

基　　金：国家自然科学基金(81670071)

摘　　要：目的探讨循环微粒水平对急性呼吸窘迫综合征患者预后评估的临床价值。方法采用前瞻性分析方法,选取2017年2月至2018年2月重庆三峡医药高等专科学校附属医院(16例)及重庆医科大学附属第二医院(22例)呼吸与危重症医学科加强治疗病房(RICU)收治的共38例ARDS患者,根据氧合指数(PaO2/FiO2),将ARDS患者分为轻(n=20)、中(n=9)、重度(n=9)三组,依据入院28d存活情况分为生存组(n=21)和死亡组(n=18),微粒捕获法检测诊断成立当天患者外周循环血浆中微粒水平,并比较各组循环微粒水平差异。应用相关分析循环微粒水平与降钙素原(PCT)、C反应蛋白(CRP)、急性生理与慢性健康评分(APACHEⅡ评分)、氧合指数、28d病死率、机械通气时间、总住院时间的相关性。采用受试者工作特征曲线(ROC)及曲线下面积(AUC)评估循环微粒数水平对ARDS28d病死率的预测值、敏感度和特异度。结果生存组ARDS患者循环微粒水平显著高于死亡组,差异有统计学意义[(3.16±1.92)μmol/L,(5.80±2.06)μmol/L;t=4.04,P=0.00)],且重度ARDS患者的循环微粒水平显著低于轻度组,差异有统计学意义[(2.81±1.96)μmol/L,(6.08±2.45)μmol/L;t=3.65,P=0.03]。循环微粒水平与患者机械通气时间呈显著负相关(r=0.81,y=19.45-1.572x,F=66.59,P=0.00),与氧合指数呈显著正相关(r=0.82,y=44.25+40.76x,F=74.37,P=0.00),但与APACHEⅡ评分、PCT、CRP、总住院时间未见显著相关。回归分析示循环微粒水平降低与ARDS28d病死率升高相关;ROC曲线示循环微粒在3.28μmol/L以下时,ARDS28d病死率明显升高,预测ARDS28d病死率的敏感度为59.0%,特异度为95.0%(AUC=0.82,95%CI:0.68~0.96,P=0.001)。结论ARDS患者急性期循环微粒水平与ARDS患者病情严重程度及预后相关。循环微粒水平可作为评估ARDS患者病情严重程度及判断预后的生物标志物,对ARDS临床治疗具有重要价值。Objective To evaluate the prognostic value of circulating microparticles (MP) in ARDS patients.Methods With a prospective investigation method,a total of 38 patients of ARDS admitted to the RICU between February 2017 and February 2018 at the Affiliated Hospital of Chongqing Three Gorges Medical college (n=16) and Second Affiliated Hospital of Chongqing Medical University (n=22) were selected for this analysis.Patients were followed until death in hospital or discharge home with unassisted breathing and then defined as non-survivors (n=17) or survivors (n=21).Circulating MP concentrations in plasma were measured by MP capture assay.Pearson correlation analysis was used for the correlation of MP and APACHE Ⅱ score, PaO2/FiO2,WBCs,neutrophils,PCT and CRP concentrations,duration of mechanical ventilation and the length of hospital stay.The prognostic value of plasma MP level was assessed by logistic regression analysis and receiver operating characteristic (ROC) curve.Results Compared with the non-survivors, the survivors maintained higher concentrations of plasma MP levels [(5.80±2.06)μmol/L and (3.16±1.92)μmol/L;t =4.04,P =0.00],compared with the mild,the severe maintained lower concentrations of plasma MP levels [(2.81±1.96)μmol/L and (6.08±2.45)μmol/L,t =3.65,P =0.03)],indicating that circulating MP level was correlated with severity and prognosis of ARDS.The circulating MP levels concentrations negatively correlated with the duration of ventilation (Y=19.45-1.572x,F =66.59,P =0.00) and positively correlated with oxygenation index (Y=44.25+40.76x,F =74.37,P =0.00).There were no correlations between the circulating MP level and APACHE Ⅱ score,WBCs,neutrophils,PCT and CRP concentrations.Deduced levels of circulating MPs are independently associated with an increased 28-day mortality of ARDS,and the sensitivity of plasma MP was 59.0% and specificity was 95%(AUC=0.82, 95%CI:0.680-0.958,P =0.001).Conclusion The circulating MP levels is valuable for prognosis and stratification of ARDS,which is of great val

关 键 词：急性呼吸窘迫综合征 急性肺损伤 循环微粒 炎性反应 微血管损伤 

分 类 号：R563.9[医药卫生—呼吸系统]