内皮细胞特异性分子-1和Presepsin对脓毒症引起的ARDS预后评估价值  

The Diagnosis and Prognosis Assessment Value of Presepsin and Endothelial Cell Specific Molecular-1 in Acute Respiratory Distress Syndrome Caused by Sepsis

作　　者：向群 殷宗宝[1] XIANG Qun;YIN Zongbao(Haikou Hospital affiliated to Xiangya School of Medicine,Central South University,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院,海口570208

出　　处：《宁夏医科大学学报》2023年第3期295-298,314,共5页Journal of Ningxia Medical University

基　　金：海口市重点科技计划项目-2014-075(2014-SKG-09-031)。

摘　　要：目的 探讨血清Presepsin和内皮细胞特异性分子-1 (ESM-1)对脓毒症引起的急性呼吸窘迫综合征(ARDS)预后评估意义。方法 选择2017年6月至2018年6月首次收治的由脓毒症引起的ARDS患者83例作为研究对象,根据第28天预后将患者分为生存组43例和死亡组40例。在入院第1天使用抗菌药前、第3、7、14天都采用酶联免疫吸附试验(ELISA)法检测血清Presepsin和内皮细胞特异性分子(ESM-1)水平,并行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。结果 生存组与死亡组患者的年龄和性别差异均无统计学意义(P均>0.05)。生存组的APACHEⅡ评分、血清Presepsin和ESM-1逐渐降低,而死亡组相反。在第7天、14天生存组的APACHEⅡ评分与死亡组差异有统计学意义(P<0.05);第3、7、14天死亡组的血清Presepsin和ESM-1水平差异均有统计学意义(P均<0.05)。以Presepsin>927.5 pg·mL^(-1)和ESM-1>4.96 ng·mL^(-1)为界值,在灵敏度方面,Presepsin第1天和第3天高于APACHEⅡ评分,在特异度方面,第3、7、14天Presepsin的均高于APACHEⅡ评分(P均<0.05);在灵敏度方面,ESM-1第1天高于APACHEⅡ评分(P<0.05),在特异度方面,第1、3、7、14天ESM-1的评分均高于APACHEⅡ评分(P均<0.05);各时间点血清Presepsin和ESM-1的AUC高于APACHEⅡ评分。结论 血清Presepsin检测能够提高早期脓毒症引起ARDS诊断率,ESM-1检测可以提高其死亡的预测能力。Objective To explore the diagnosis and prognosis assessment value of presepsin and endothelial cell specific molecular-1 in acute respiratory distress syndrome caused by sepsis. Methods A total of 83 patients with acute respiratory distress syndrome(ARDS) caused by sepsis who were first admitted to the ICU of the Emergency Department of Haikou People’s Hospital from June 2017 to June 2018 were selected as the study subjects. According to the 28-day prognosis,the patients with ARDS caused by sepsis were divided into survival group(43 cases) and death group(40 cases). The levels of serum presepsin and endothelial cell specific molecule-1(ESM-1) were detected by enzyme-linked immunosorbent assay(ELISA) before the use of antibacterial drugs on the first day of admission,the third day,the seventh day and the fourteenth day,and the acute physiology and chronic health status scoring systemⅡ(APACHEⅡ) was scored.Results There was no significant difference in age and sex between survival group and death group(P all>0.05).The APACHE-Ⅱscore,serum presepsin,and ESM-1 decreased gradually in the survival group,but not in the death group.The APACHEⅡscore in the survival group was statistically significant compared with that in the death group on day 7 and day 14(P<0.05).Serum presepsin and ESM-1 levels in the death group were statistically significant compared with those in the survival group on day 3,7,and 14(P all<0.05).By used as the cut-off values presepsin>927.5 pg·mL^(-1) and ESM-1>4.96 ng·mL^(-1),the sensitivity of presepsin on day 1 and day 3 was different from those of APACHEⅡ.There was a difference between ESM-1 and APACHEⅡon day 1(P all<0.05).The specificity of presepsin differed from APACHEⅡscores at day 3,7,and 14(P<0.05),and ESM-1 was different from APACHEⅡat each time point(P all<0.05).Conclusion Serum presepsin detection can improve the diagnostic rate of ARDS caused by early sepsis,and ESM-1 detection can improve the predictive ability of ARDS.

关 键 词：脓毒症 急性呼吸窘迫综合征 可溶性白细胞分化抗原14亚型 内皮细胞特异性分子-1 预后 

分 类 号：R563.8[医药卫生—呼吸系统] R459.7[医药卫生—内科学]