脓毒症并发急性呼吸窘迫综合征患者血清FGF21、SP-A表达及其与预后的关系  

Expression of serum FGF21 and SP-A in patients with sepsis complicated with acute respiratory distress syndrome and their relationship with prognosis

作　　者：张龙玉 梁连春[1] 马春华[1] 段忠辉[1] 张寅[1] ZHANG Long-yu;LIANG Lian-chun;MA Chun-hua(Department of Infectious Diseases,Beijing You'an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染综合科,北京100069

出　　处：《临床和实验医学杂志》2023年第1期8-12,共5页Journal of Clinical and Experimental Medicine

基　　金：军事科学院院长基金(编号:JK2020NC019);国家“十三五”传染病科技重大专项子课题(编号:2017X10205502)。

摘　　要：目的 探究脓毒症并发急性呼吸窘迫综合征(ARDS)患者成纤维细胞生长因子-21(FGF21)、肺表面活性蛋白A(SP-A)表达及其与预后的关系。方法 回顾性选取2016年3月至2020年3月首都医科大学附属北京佑安医院感染综合科重症监护室收治的脓毒症并发ARDS患者102例和未并发ARDS患者67例。对于脓毒症并发ARDS患者,根据入院24 h内氧合指数(PaO_(2)/FiO_(2))将其分为轻度组(n=31)、中度组(n=49)和重度组(n=22);根据入院后28 d内生存情况,将其分为存活组(n=72)和死亡组(n=30)。利用酶联免疫吸附试验检测血清FGF21、SP-A水平并比较;采用Pearson检验分析脓毒症并发ARDS患者血清FGF21、SP-A水平与急性生理和慢性健康状况评分(APACHEⅡ)的相关性;利用受试者工作特征(ROC)曲线评价血清FGF21、SP-A对脓毒症并发ARDS患者预后不良的预测价值;利用多因素Logistic回归分析,探讨影响脓毒症并发ARDS患者预后不良的危险因素。结果 与脓毒症未并发ARDS患者相比,脓毒症并发ARDS患者血清FGF21水平[(711.50±228.34) pg/mL vs.(349.64±105.92) pg/mL]明显升高,SP-A[(21.02±6.83)ng/mL vs.(34.36±7.59)ng/mL]水平明显降低,差异均有统计学意义(P<0.05)。脓毒症并发ARDS轻度组、中度组、重度组患者血清FGF21水平依次明显升高,SP-A水平依次明显降低,差异均有统计学意义(P<0.05)。死亡组PaO_(2)/FiO_(2)值、SP-A水平明显低于存活组,APACHEⅡ评分、FGF21水平及机械通气时间≥4 d、住ICU时间≥12 d人数占比明显高于存活组,差异均有统计学意义(P<0.05)。脓毒症并发ARDS患者血清FGF21水平与APACHEⅡ评分呈正相关(r=0.503,P<0.001),血清SP-A水平与APACHEⅡ评分呈负相关(r=-0.655,P<0.001)。血清FGF21、SP-A水平评估脓毒症并发ARDS患者预后不良的曲线下面积(AUC)分别为0.801(95%CI:0.700~0.903)、0.812(95%CI:0.728~0.896),最佳截断值分别为691.22 pg/mL、21.48 ng/mL;血清FGF21、SP-A联合预测脓毒症并发ARDObjective To investigate the expression of fibroblast growth factor-21(FGF21), surfactant protein A(SP-A) and their relationship with prognosis in patients with sepsis complicated with acute respiratory distress syndrome(ARDS). Methods A total of 102 patients with sepsis complicated with ARDS and 67 patients without ARDS in intensive care unit of Beijing You’an Hospital, Capital Medical University from March 2016 to March 2020 were selected. According to oxygenation index(PaO_(2)/FiO_(2)) within 24 hours after admission, the patients with sepsis complicated with ARDS were divided into mild group(n=31), moderate group(n=49) and severe group(n=22);according to the survival condition within 28 days after admission, the patients were divided into survival group(n=72) and death group(n=30). Enzyme linked immunosorbent assay was used to detect the levels of serum FGF21 and SP-A. Pearson test was used to analyze the correlation between serum FGF21, SP-A levels and acute physiological and chronic health scores(APACHEⅡ) score in patients with sepsis complicated with ARDS;Receiver operating characteristic curve(ROC) was used to evaluate the predictive value of serum FGF21 and SP-A for poor prognosis of sepsis complicated with ARDS;multivariate Logistic regression was used to analyze the risk factors of poor prognosis in patients with sepsis complicated with ARDS. Results Compared with those in sepsis patients without ARDS, the level of serum FGF21 [(711.50±228.34) pg/mL vs.(349.64±105.92) pg/mL] in sepsis patients with ARDS was significantly increased, and the level of SP-A [(21.02±6.83) ng/mL vs.(34.36±7.59) ng/mL] was significantly decreased, the differences were statistically significant(P<0.05). The level of serum FGF21 was significantly increased in mild group, moderate group and severe group, and the level of SP-A was significantly decreased in turn, the differences were statistically significant(P<0.05). The PaO_(2)/FiO_(2)value and SP-A level in death group were significantly lower than those in survival gr

关 键 词：脓毒症并发急性呼吸窘迫综合征 成纤维细胞生长因子-21 肺表面活性蛋白A 预后评估 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]