血管生成素-2及可溶性糖基化终末产物受体在脓毒症相关急性呼吸窘迫综合征发病中的作用  

The role of Angiotensin-2 and soluble receptor for advanced glycation end products in the pathogenesis of septic associated Acute respiratory distress syndrome

作　　者：李金兰 张丽中[1] 樊柳汝 李筱妍[1] LI Jinlan;ZHANG Lizhong;FAN Liuru;LI Xiaoyan(Department of Respiratory and Critical Care Medicine,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,China)

机构地区：[1]山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院)呼吸与危重症医学科,太原030032

出　　处：《实用医学杂志》2022年第24期3095-3099,3105,共6页The Journal of Practical Medicine

基　　金：山西省留学人员科技活动择优资助项目(编号:20200030)。

摘　　要：目的本研究旨在探索血管生成素-2(Ang-2)及可溶性糖基化终末产物受体(sRAGE)表达在脓毒症相关急性呼吸窘迫综合征(ARDS)发病中的作用,评估其对脓毒症相关ARDS的发生起到早期预测作用。方法收集2021年5月至2022年1月于山西白求恩医院住院的脓毒症相关ARDS患者作为研究组,脓毒症患者作为病例对照组,同期于本院体检中心进行健康体检的成人为健康对照组。追踪随访研究组患者28 d转归情况,分为存活组9例和死亡组8例。比较各组受试者Ang-2及sRAGE表达水平及实验室指标(白细胞计数、中性粒细胞计数、淋巴细胞数、中性粒细胞及淋巴细胞比值、单核细胞数及嗜酸性粒细胞数)的差异,并分析脓毒症相关ARDS发病的危险因素,以及Ang-2和sRAGE对脓毒症相关ARDS早期识别的诊断效能。结果三组Ang-2及sRAGE表达水平比较差异均有统计学意义(分别P<0.01,P<0.05)。而且与病例对照组(3378.06/912.67,1343.63/334.49)及健康对照组(2852.48/411.97,1365.53/211.54)相比,研究组Ang-2及sRAGE表达水平(4031.28/815.26,1514.86/344.44)显著增高,差异均有统计学意义(均P<0.05)。采用多因素logistic回归分析显示,Ang-2及sRAGE是脓毒症相关ARDS发病的高危因素(分别P<0.05,P<0.01)。绘制ROC曲线,发现Ang-2和sRAGE高表达在脓毒症相关ARDS早期识别中均有一定的诊断价值,但sRAGE(AUC为0.702,敏感性为76.5%,特异性为45.5%)的诊断效能不如Ang-2(AUC为0.724,敏感性为94.1%,特异性为48.3%),且后者与研究组28 d高死亡风险明显相关(P<0.05)。结论脓毒症相关ARDS组患者Ang-2和sRAGE表达明显增高,且Ang-2和sRAGE高表达是脓毒症相关ARDS发病的高危因素。Ang-2和sRAGE高表达在脓毒症相关ARDS早期识别中的均有一定的诊断价值,但sRAGE的诊断效能不如Ang-2,且后者与研究组28 d高死亡风险明显相关。Objective To investigate the role of Ang-2 and sRAGE in the pathogenicity of sepsis related ARDS,and to evaluate whether Ang-2 and sRAGE can play an role in theearly diagnosis of sepsis related ARDS.Method Patients with sepsis related ARDS were enrolled as the experimental group in Shanxi Bethune Hospital from May 2021 to January 2022,patients with sepsis as the case control group,and healthy adults who underwent physical examination at the physical examination center during the same period were enrolled as the healthy control group.Patients in the experimental group were followed up for 28 days,and were divided into the survival group(n=9)and the death group(n=8).The expression level of Ang-2 and sRAGE and the number or rate of laboratory indicators(WBC,NEUT,LY,NLR,MONO and EO)in each group were compared,and the risk factors of sepsis related ARDS and the diagnostic power of Ang-2 and sRAGE in the early recognition of sepsis related ARDS were analyzed.Results There were statistically significant differences in the expression level of Ang-2 and sRAGE among the three groups(P<0.01,P<0.05 respectively).Moreover,compared with the case control group(3378.06/912.67,1343.63/334.49)and the healthy control group(2852.48/411.97,1365.53/211.54),the expression level of Ang-2 and sRAGE in experimental groups(4031.28/815.26,1514.86/344.44)is notablely increased(P<0.05).Multivariate Logistic regression analysis showed that Ang-2 and sRAGE were the risk factors for sepsis related ARDS(P<0.05,P<0.01respectively).ROC curve was plotted and it was found that the high level of Ang-2 and s RAGE had certain diagnostic value in the early identification of sepsis related ARDS.However,the diagnostic power of sRAGE(AUC 0.702,sensitivity 76.5%,specificity 45.5%)was inferior to that of Ang-2(AUC 0.724,sensitivity 94.1%,Specificity 48.3%),and the latter was evidently associated with a higher deathrisk at 28 days in the experimental group(P<0.05).Conclusion The expression level of Ang-2 and sRAGE is markedly increased in patients with sepsis

关 键 词：血管生成素-2 可溶性糖基化终末产物受体 脓毒症 急性呼吸窘迫综合征 

分 类 号：R446.1[医药卫生—诊断学]