多配体聚糖-1检测联合肺部超声评估ARDS患者血管外肺水的程度  

Evaluation of extravascular lung water in patients with acute respiratory distress syndrome by syndecan-1 combined with lung ultrasonography

作　　者：高嵩[1] 吴丁烨[1] 高飞[1] 严洁[1] 梁锋鸣[1] 惠姣洁[1] Gao Song;Wu Dingye;Gao Fei;Yan Jie;Liang Fengming;Hui Jiaojie(Department of Intensive Care Unit,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,Jiangsu,China)

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏无锡214023

出　　处：《中华危重病急救医学》2021年第8期990-993,共4页Chinese Critical Care Medicine

基　　金：江苏省青年医学重点人才培养项目(QNRC2016178);江苏省临床重点专科建设项目(2019-10)。

摘　　要：目的探讨血浆多配体聚糖-1(SDC-1)检测联合肺部超声对急性呼吸窘迫综合征(ARDS)患者血管外肺水程度的评估价值。方法选择2018年7月至2019年7月南京医科大学附属无锡市人民医院重症医学科诊断为ARDS的患者共50例。患者入科后均置入脉搏指示连续心排血量监测(PiCCO)导管,由1名医生监测PiCCO指标,包括血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI),由另一名医生进行肺部超声检查,计算双肺的上蓝点、下蓝点、膈肌点、Plaps点、后蓝点共10个超声切面下的B线数目之和,随后用酶联免疫吸附试验(ELISA)检测血浆SDC-1水平。采用Pearson相关法分析超声B线数目、血浆SDC-1水平与EVLWI、PVPI的相关性。以10 mL/kg EVLWI为界值将ARDS患者肺水肿程度分为轻度和重度,绘制受试者工作特征曲线(ROC曲线),分析B线数目、SDC-1以及两者联合对ARDS患者肺水肿程度的预测价值。结果50例ARDS患者心排血指数(CI)为(46.84±6.00)mL·s^(-1)·m^(-2),中心静脉压(CVP)为(8.12±1.80)mmHg(1 mmHg=0.133 kPa),均排除心源性肺水肿。50例ARDS患者EVLWI为(10.82±2.92)mL/kg,PVPI为3.02±0.69,超声B线数目为(40.90±13.05)条,血浆SDC-1为(568.25±118.14)μg/L。Pearson相关性分析显示,ARDS患者超声B线数目与EVLWI(r=0.802)、PVPI(r=0.799)均呈显著正相关(均P<0.01);血浆SDC-1与EVLWI(r=0.732)、PVPI(r=0.576)同样呈显著正相关(均P<0.01)。ROC曲线分析显示,B线数目、SDC-1对ARDS患者肺水肿严重程度均有良好的预测价值,ROC曲线下面积(AUC)和95%可信区间(95%CI)分别为0.891(0.803~0.979)、0.875(0.772~0.978);当B线阈值为40.50条时,其敏感度和特异度分别为82.1%、86.4%;当SDC-1阈值为559.37μg/L时,其敏感度和特异度分别为85.7%、81.8%。将B线数目与SDC-1联合可进一步提高对ARDS患者肺水肿程度的预测价值,其AUC(95%CI)为0.958(0.890~1.000),敏感度和特异度分别为92.9%、91.8%。结论血浆SDC-1和肺部超声B线数目与AObjective To investigate the value of plasma syndecan-1(SDC-1)combined with lung ultrasonography in evaluating the degree of extravascular lung water in patients with acute respiratory distress syndrome(ARDS).Methods From July 2018 to July 2019,50 patients with ARDS admitted to the department of intensive care unit of Wuxi People's Hospital Affiliated to Nanjing Medical University were enrolled.After admission,pulse indicator continuous cardiac output(PiCCO)catheter was established for all patients.PiCCO indexes,including extravascular lung water index(EVLWI)and pulmonary vascular permeability index(PVPI)were monitored by one doctor.Another doctor performed lung ultrasound examination,and calculated the sum of the number of B-lines under 10 ultrasound sections of upper blue point,lower blue point,diaphragm point,Plaps point and rear blue point of both lungs.Then the level of plasma SDC-1 was detected by enzyme linked immunosorbent assay(ELISA).Pearson correlation method was used to analyze the correlation between the number of ultrasonic B-lines,plasma SDC-1 level and EVLWI and PVPI.Taking 10 mL/kg EVLWI as the boundary value,the degree of pulmonary edema in patients with ARDS was divided into mild pulmonary edema and severe pulmonary edema.The receiver operator characteristic curve(ROC curve)was drawn,and the number of B-lines,SDC-1 and the predictive value of the combination of the above two indicators on the severity of pulmonary edema in patients with ARDS were analyzed.Results The cardiac index(CI)and central venous pressure(CVP)of 50 patients with ARDS were(46.84±6.00)mL·s^(-1)·m^(-2)and(8.12±1.80)mmHg(1 mmHg=0.133 kPa),cardiogenic pulmonary edema was excluded.In 50 patients with ARDS,EVLWI was(10.82±2.92)mL/kg,PVPI was 3.02±0.69,the number of ultrasound B-lines was 40.90±13.05,and plasma SDC-1 was(568.25±118.14)μg/L.Pearson correlation analysis showed that the number of ultrasound B-lines in patients with ARDS was significantly positively correlated with EVLWI and PVPI(r1=0.802,r2=0.799,both P<0.0

关 键 词：急性呼吸窘迫综合征 血管外肺水指数 血浆多配体聚糖-1 肺部超声 

分 类 号：R563.8[医药卫生—呼吸系统]