脓毒症并发急性呼吸窘迫综合征患者血清ESM-1水平变化及对预后的预测价值  

Changes of serum ESM-1 level in sepsis patients complicated with acute respiratory distress syndrome and its prognostic value for prognosis

作　　者：孙炜 陈寒艳 林桂芬[1] 陈红兴 SUN Wei;CHEN Hanyan;LIN Guifen;CHEN Hongxing(The Affiliated Hospital of Jiangnan University,Wuxi 214062,China)

机构地区：[1]江南大学附属医院,江苏无锡214062

出　　处：《山东医药》2020年第25期14-17,34,共5页Shandong Medical Journal

基　　金：江苏省科技计划项目(BK20174025)。

摘　　要：目的探讨血清内皮细胞特异性分子-1(ESM-1)在脓毒症并发急性呼吸窘迫综合征(ARDS)患者中的水平变化及其对预后的预测价值。方法收集95例脓毒症患者临床病历资料,根据入院后72 h内是否并发ARDS分为ARDS组(n=36)、非ARDS组(n=59),ARDS组根据住院期间是否死亡分为死亡组(n=15)、存活组(n=21)。并于同期随机选取60例全身炎症反应综合征患者(SIRS组)和60例健康体检者(对照组)作为对照。采用酶联免疫吸附法检测各组入院时血清ESM-1、C反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT),同时检测氧合指数。采用Pearson积矩相关分析血清ESM-1与CRP、IL-6、PCT、氧合指数的相关性;采用受试者工作特征(ROC)曲线评估血清ESM-1水平对脓毒症合并ARDS患者住院期间死亡的预测价值。结果ARDS组、非ARDS组、SIRS组血清ESM-1水平高于对照组,ARDS组、非ARDS组高于SIRS组,ARDS组高于非ARDS组(P均<0.05)。死亡组血清ESM-1水平高于存活组(P<0.05)。ARDS组血清ESM-1水平与血清CRP、IL-6、PCT水平呈正相关(r分别为0.637、0.692、0.655,P均<0.05),与氧合指数呈负相关(r=-0.702,P<0.05)。血清ESM-1、CRP、IL-6、PCT对脓毒症合并ARDS患者住院期间死亡均有预测价值,其中血清ESM-1水平的预测价值最显著,ROC曲线下面积为0.900(95%CI:0.865~0.934),灵敏度、特异度分别为0.89、0.82,准确性为0.87。结论ESM-1异常升高参与了脓毒症患者ARDS发病过程,并与病情严重性密切相关,早期检测有望作为预测脓毒症并发ARDS患者预后的生化指标。Objective To investigate the change of serum endothelial specific molecule-1(ESM-1)in sepsis patients complicated with acute respiratory distress syndrome(ARDS)and its prognostic value for prognosis.Methods Clinical data of 95 sepsis patients were collected,and they were divided into ARDS group(n=36)and non-ARDS group(n=59)according to whether ARDS occurred within 72 hours after admission.Patients in the ARDS group were divided into death group(n=15)and survival group(n=21)according to whether they died during hospitalization.In addition,60 patients with systemic inflammatory response syndrome(SIRS group)and 60 healthy subjects(control group)were randomly selected during the same period.The serum levels of ESM-1,C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)in the four groups at admission were detected by ELISA,and the oxygenation index was also detected.Pearson product moment correlation was used to analyze the correlation between serum ESM-1 and CRP,IL-6,PCT and oxygenation index;receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum ESM-1 on the death of sepsis patients with ARDS during hospitalization.Results The serum ESM-1 levels of the ARDS group,non-ARDS group and SIRS group were higher than that of control group,those of the ARDS group and non-ARDS group were higher than that of the SIRS group,and that of the ARDS group was higher than that of the non-ARDS group(all P<0.05).The level of ESM-1 in the death group was higher than that in the survival group(P<0.05).In the ARDS group,serum ESM-1 was positively correlated with CRP,IL-6 and PCT(r=0.637,0.692,0.655,respectively;all P<0.05),and was negatively correlated with oxygenation index(r=-0.702,P<0.05).Serum ESM-1,CRP,IL-6,and PCT had predictive value for the death of sepsis patients complicated with ARDS during hospitalization,among which ESM-1 had the most significant predictive value,the area under ROC curve was 0.900(95%CI:0.865-0.934),the sensitivity and specificity were 0.89 and 0.82,respecti

关 键 词：脓毒症 急性呼吸窘迫综合征 内皮细胞特异性分子-1 预测价值 

分 类 号：R563.8[医药卫生—呼吸系统]