血清抑制素A对急性呼吸窘迫综合征患者预后的评估价值  

The prognostic value of serum inhibin A in patients with acute respiratory distress syndrome

作　　者：姜文娟 贺芬[1] 张旭 任阳[2] JIANG Wenjuan;HE Fen;ZHANG Xu;REN Yang(Department of Critical Care Medicine,The Affiliated Hospital of Yan'an University,Yan’an 716000,Shanxi,China;Geriatrics Department,The Affiliated Hospital of Yan'an University,Yan’an 716000,Shanxi,China)

机构地区：[1]延安大学附属医院重症医学科,陕西延安716000 [2]延安大学附属医院老年病科,陕西延安716000

出　　处：《西部医学》2023年第1期102-106,共5页Medical Journal of West China

基　　金：陕西省社会发展科技攻关项目(2016SF-075)。

摘　　要：目的探讨血清抑制素A对急性呼吸窘迫综合征(ARDS)患者预后的评估价值。方法选取2017年6月~2020年9月延安大学附属医院收治的102名ARDS患者为观察对象,根据患者预后情况分为死亡组(48例)和存活组(54例),同时根据疾病严重程度分为轻度组(22例)、中度组(42例)和重度组(38例)。应用酶联免疫吸附法测定血清抑制素A及相关炎症指标水平。比较不同严重程度ARDS患者血清抑制素A水平差异,应用ROC曲线分析各指标对ARDS死亡的诊断价值,采用多因素Logistic逐步回归模型探讨ARDS发生死亡的相关因素。结果与存活组比较,死亡组WBC、ALB、AST、GGT水平升高(P<0.05),而Hb、HCT、PLT、TBIL、DBIL、GLU、Ca、Cr、CHOL、HDL-C、LDL-C、TG水平比较差异无统计学意义(P>0.05)。与存活组比较,死亡组血清IL-4、TNF-α、hs-CRP水平和APACHEⅡ评分升高,差异均有统计学意义(P<0.05)。与存活组比较,死亡组血清抑制素A水平升高(P<0.05)。与ARDS轻度组比较,ARDS中度组和ARDS重度组血清抑制素A水平升高(P<0.05);随着ARDS病情逐渐严重,血清抑制素A水平逐渐升高(P<0.05)。血清抑制素A与IL-4、WBC、ALB、TNF-α、hs-CRP、APACHEⅡ评分呈正相关(P<0.05)。血清抑制素A诊断急性呼吸窘迫综合征患者发生死亡的AUC、灵敏度、特异度明显高于hs-CRP和APACHEⅡ评分(P<0.05)。多因素Logistics回归分析显示,高水平抑制素A、hs-CRP、APACHEⅡ评分为急性呼吸窘迫综合征患者发生死亡的危险因素(P<0.05)。结论血清抑制素A评估急性呼吸窘迫综合征预后具有较高的灵敏度、特异度,其升高为急性呼吸窘迫综合征患者预后的危险因素。Objective To investigate the prognostic value of serum inhibin A in patients with acute respiratory distress syndrome.Methods A total of 102 ARDS patients admitted to The Affiliated Hospital of Yan'an University from June 2017 to September 2020 were selected as the research objects.According to the prognosis of the patients.They were divided into death group(48 cases)and survival group(54 cases),and according to the severity of the disease,they were divided into mild group(22 cases),moderate group(42 cases)and severe group(38 cases).Enzyme linked immunosorbent assay(ELISA)was used to determine the levels of serum inhibit A and related inflammatory markers.The difference of serum inhibit A levels among each group was compared.The diagnostic value of each index in the death of ARDS was analyzed by ROC curve.The related factors of death of ARDS were discussed by multivariate logistic regression model.Results Compared with the survival group,the levels of WBC,ALB,AST and GGT increased in the death group of ARDS(P<0.05),but there was no significant difference in the levels of Hb,HCT,PLT,TBIL,DBIL,Glu,CA,Cr,CHOL,HDL-C,LDL-C and TG(P>0.05).Compared with the survival group,the levels of IL-4,TNF-α,Hs-CRP and APACHEⅡscore in the death group increased,and the differences were statistically significant(P<0.05).Compared with the survival group,the serum inhibit A level in the death group was higher(P<0.05).Compared with mild ARDS group,the serum inhibit A level in moderate and severe ARDS groups was higher(P<0.05),and with the severity of ARDS,the serum inhibit A level gradually increased(P<0.05).Serum inhibit A was positively correlated with IL-4,WBC,ALB,TNF-α,Hs-CRP and APACHEⅡscore(P<0.05).The AUC,sensitivity and specificity of serum inhibit A in the diagnosis of death in patients with acute respiratory distress syndrome were 0.898(95%CI:0.848-0.955),85.4%and 85.2%,respectively,which were significantly higher than those of hs-CRP and APACHEⅡscore(P<0.05).Multivariate logistic regression analysis showed that high l

关 键 词：血清抑制素A 急性呼吸窘迫综合征 预后 临床价值 

分 类 号：R563.8[医药卫生—呼吸系统]