血清HMGB1、ESM-1水平对脓毒症并发ARDS的预测价值  

Predictive value of serum HMGB1 and ESM-1 in sepsis complicated with ARDS

作　　者：郭小芙[1] 席与斌[1] 陈刚[1] GUO Xiaofu;XI Yubin;CHEN Gang(Suzhou Municipal Hospital,Suzhou 215000,China)

机构地区：[1]苏州市立医院,江苏苏州215000

出　　处：《山东医药》2020年第31期28-31,共4页Shandong Medical Journal

基　　金：江苏省卫生计生委科研课题(H201751)。

摘　　要：目的探讨血清高迁移率族蛋白B1(HMGB1)、内皮细胞特异性分子1(ESM-1)水平对脓毒症并发急性呼吸窘迫综合征(ARDS)的预测价值。方法选择123例脓毒症患者,其中39例合并ARDS(ARDS组)、84例未合并ARDS(NARDS组),另选择51例门诊体检健康志愿者(对照组)。检测三组血清HMGB1、ESM-1,收集患者临床资料,采用Logistic回归分析影响脓毒症合并ARDS的危险因素,采用受试者工作特征(ROC)曲线分析血清HMGB1、ESM-1、HMGB1+ESM-1预测脓毒症合并ARDS的价值。结果ARDS组血清HMGB1、ESM-1水平高于NARDS组和对照组(P均<0.05),NARDS组血清HMGB1、ESM-1水平高于对照组(P均<0.05)。单因素分析结果显示,ARDS组脓毒症休克比例、肺部感染比例、合并肾功能不全比例、脏器功能衰竭个数≥2个比例、APACHEⅡ评分均高于NARDS组(P均<0.05)。Logistic回归分析结果显示,肺部感染、APACHEⅡ评分、HMGB1、ESM-1水平是脓毒症患者合并ARDS的危险因素(P均<0.01)。ROC曲线分析结果显示,血清HMGB1、ESM-1、HMGB1+ESM-1水平预测脓毒症合并ARDS的曲线下面积(AUC)分别为0.754、0.651、0.921,灵敏度分别为74.36%、71.79%、84.62%,特异度分别为80.95%、75.00%、95.24%。结论脓毒症合并ARDS患者血清HMGB1、ESM-1水平升高,高水平HMGB1、ESM-1与脓毒症患者并发ARDS关系密切,二者可作为脓毒症并发ARDS预测的参考指标。Objective To investigate the predictive value of serum high mobility group protein B1(HMGB1)and endothelial cell specific molecule-1(ESM-1)in sepsis complicated with acute respiratory distress syndrome(ARDS).Methods Totally 123 patients with sepsis,including 39 patients with ARDS(ARDS group)and 84 patients without ARDS(NARDS group),and meanwhile 51 healthy volunteers with outpatient physical examination(control group)were selected.The levels of serum HMGB1 and ESM-1 in the three groups were detected,and the clinical data of the patients were collected.The risk factors affecting sepsis complicated with ARDS were analyzed by Logistic regression.The value of serum HMGB1,ESM-1 and HMGB1+ESM-1 in predicting sepsis complicated with ARDS was analyzed by receiver operating characteristic(ROC)curve.Results Serum HMGB1 and ESM-1 levels in the ARDS group were higher than those of the NARDS group and the control group(all P<0.05),and serum HMGB1 and ESM-1 levels of the NARDS group were higher than those of the control group(both P<0.05).Univariate analysis results showed that the proportions of sepsis shock,pulmonary infection,renal insufficiency,organ failure≥2,and APACHEⅡscore in the ARDS group were higher than those in the NARDS group(all P<0.05).Logistic regression analysis results showed that pulmonary infection,APACHEⅡscore,high level of HMGB1,ESM-1 were risk factors for sepsis patients with ARDS(all P<0.01).ROC curve analysis results showed that the area under the curve(AUC)of serum HMGB1,ESM-1 and HMGB1+ESM-1 in predicting sepsis complicated with ARDS were 0.754,0.651,and 0.921,respectively.The sensitivities were 74.36%,71.79%and 84.62%,respectively;and the specificities were 80.95%,75.00%,and 95.24%,respectively.Conclusion Serum levels of HMGB1 and ESM-1 in patients with sepsis complicated with ARDS increase,and the high levels of HMGB1 and ESM-1 are closely correlated with ARDS in sepsis patients,which can be used as a predictor of ARDS for patients with sepsis.

关 键 词：脓毒症 急性呼吸窘迫综合征 脓毒症休克 肺部感染 脏器功能衰竭 高迁移率族蛋白B1 内皮细胞特异性分子1 APACHEⅡ评分 

分 类 号：R631[医药卫生—外科学]