血清激活素A和Clara细胞分泌蛋白-16及脑钠肽水平对急性呼吸窘迫综合征患者预后预测的临床意义  

Clinical significance of serum activin-A,Clara cell secretory protein-16 and brain natriuretic peptide levels in the prognosis of patients with acute respiratory distress syndrome

作　　者：梁莉荣 陈钰 梁勇 肖成钦 黄一桂 Liang Lirong;Chen Yu;Liang Yong;Xiao Chengqin;Huang Yigui(Department of Respiratory,the Third People's Hospital of Haikou,Haikou 571100,Hainan,China)

机构地区：[1]海口市第三人民医院呼吸内科,海南海口571100

出　　处：《中国中西医结合急救杂志》2023年第1期26-30,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：海南省医药卫生科研基金项目(18A200283)。

摘　　要：目的探讨血清激活素A(Activin-A)、Clara细胞分泌蛋白-16(CC-16)及脑钠肽(BNP)水平与急性呼吸窘迫综合征(ARDS)患者病情严重程度的关系,及其预测预后的价值。方法采用回顾性研究方法,收集2017年1月至2020年9月海口市第三人民医院收治的ARDS患者的临床资料,包括发病当天的一般资料及入重症监护病房(ICU)1、3、7 d血清Activin-A、CC-16、BNP水平。根据氧合指数(PaO_(2)/FiO_(2))将ARDS患者分为轻度组(200 mmHg<PaO_(2)/FiO_(2)≤300 mmHg,1 mmHg≈0.133 kPa)、中度组(100 mmHg<PaO_(2)/FiO_(2)≤200 mmHg)、重度组(PaO_(2)/FiO_(2)≤100 mmHg);根据入ICU 28 d内的生存情况将ARDS患者分为存活组和死亡组。分析不同病情严重程度和不同预后ARDS患者血清Activin-A、CC-16、BNP水平的变化趋势;绘制受试者工作特征曲线(ROC曲线),分析血清Activin-A、CC-16、BNP水平对ARDS患者28 d死亡的预测价值。结果共入选103例ARDS患者,其中轻度ARDS 20例,中度ARDS 41例,重度ARDS 42例;28 d存活68例,死亡35例。不同病情程度及不同预后各组患者入ICU后1、3、7 d血清Activin-A、CC-16、BNP水平逐渐升高,均于3 d时达峰值,且ARDS重度组入ICU 1、3、7 d各指标均明显高于ARDS轻中度组〔Activin-A(ng/L):1395.36±164.20比806.40±121.75,1683.25±190.17比865.35±136.40,1594.80±172.65比842.50±124.37;CC-16(ng/L):63.58±15.30比53.48±13.37,89.24±19.38比57.85±15.36,82.62±15.74比54.60±13.26;BNP(ng/L):401.86±118.45比254.36±72.50,560.74±175.30比326.62±84.37,592.35±184.73比286.24±76.25,均P<0.01〕。死亡组入ICU 1、3、7 d各指标均明显高于存活组〔Activin-A(ng/L):1410.27±171.38比730.50±108.35,1820.36±205.37比806.25±121.27,1750.38±181.42比775.38±116.20;CC-16(ng/L):70.26±15.38比45.37±11.86,95.68±22.73比51.26±13.05,86.92±19.64比49.36±12.85;BNP(ng/L):452.73±131.62比205.60±63.24,615.60±190.37比272.35±81.50,648.25±210.62比238.36±68.40,均P<0.01〕。ROC曲线分析显示,各时间点血清Objective To investigate the relationship between the levels of serum activin-A(Activin-A),Clara cell secretory protein-16(CC-16),brain natriuretic peptide(BNP)and the severity of acute respiratory distress syndrome(ARDS),and the value of predicting prognosis.Methods A retrospective study was conducted.The clinical data of ARDS patients admitted to the Third People's Hospital of Haikou from January 2017 to September 2020 were collected,including the general data on the day of onset,and the levels of serum Activin-A,CC-16 and BNP at 1,3 and 7 days in ICU.According to the oxygenation index(PaO_(2)/FiO_(2)),ARDS patients were divided into mild group(200 mmHg<PaO_(2)/FiO_(2)≤300 mmHg,1 mmHg≈0.133 kPa),moderate group(100 mmHg<PaO_(2)/FiO_(2)≤200 mmHg),and severe group(PaO_(2)/FiO_(2)≤100 mmHg).The patients with ARDS were divided into survival group and death group according to the survival condition within 28 days.The changes of serum Activin-A,CC-16 and BNP levels in patients with ARDS with different severity and prognosis were analyzed.The receiver operating characteristic curve(ROC curve)was drawn to analyze the value of serum Activin-A,CC-16 and BNP levels in predicting 28-day death of ARDS patients.Results A total of 103 patients with ARDS were enrolled,including 20 cases of mild ARDS,41 cases of moderate ARDS,and 42 cases of severe ARDS;68 cases of 28-day survival and 35 cases of death.The levels of serum Activin-A,CC-16 and BNP in different severity and prognosis groups increased gradually on the 1st,3rd and 7th day after ICU admission,and reached the peak on the 3rd day.The indexes of severe ARDS group were significantly higher than those of mild and moderate ARDS group on the 1st,3rd and 7th day after ICU admission[Activin-A(ng/L):1395.36±164.20 vs.806.40±121.75,1683.25±190.17 vs.865.35±136.40,1594.80±172.65 vs.842.50±124.37;CC-16(ng/L):63.58±15.30 vs.53.48±13.37,89.24±19.38 vs.57.85±15.36,82.62±15.74 vs.54.60±13.26;BNP(ng/L):401.86±118.45 vs.254.36±72.50,560.74±175.30 vs.326.62±84.37,

关 键 词：急性呼吸窘迫综合征 激活素A Clara细胞分泌蛋白-16 脑钠肽 预后 预测 

分 类 号：R563.8[医药卫生—呼吸系统]