sPDPN在老年脓毒症性肺损伤病人早期诊断、病情及预后评估中的价值研究  

Value of soluble podoplanin in early diagnosis,severity and prognosis assessment foRelderly patients with septic lung injury

作　　者：衡军锋[1] 郑开明 吴丁烨[1] HENG Jun-feng;ZHENG Kai-ming;WU Ding-ye(Department of ICU,Wuxi People’s Hospital,Wuxi 214000,China;Department of Neurology,Suqian Traditional Chinese Medicine Hospital,Suqian 223800,China)

机构地区：[1]无锡市人民医院ICU,江苏省无锡市214000 [2]宿迁市中医院神经内科,江苏省宿迁市223800

出　　处：《实用老年医学》2023年第8期767-771,共5页Practical Geriatrics

基　　金：第四批全国中医临床优秀人才(432123)。

摘　　要：目的研究血浆中可溶性平足蛋白(soluble podoplanin,sPDPN)对老年脓毒症性肺损伤病人早期诊断、病情分级、预后评估的价值。方法选取2018年1月至2020年12月收住无锡市人民医院ICU的老年脓毒症病人共95例,分为脓毒症组(40例)和脓毒症肺损伤组(55例)。将脓毒症肺损伤病人根据病情细分为脓毒症合并急性呼吸窘迫综合征(ARDS)亚组(脓毒症伴有ARDS,29例)和脓毒性休克合并ARDS亚组(脓毒性休克伴有ARDS,26例);根据病人的28 d转归情况分为存活亚组(40例)和死亡亚组(15例)。对照组为同期健康体检老年人30例。观察并记录病人收入ICU当日一般情况及APACHEⅡ评分、序贯性器官功能衰竭(SOFA)评分、血管外肺水(EVLW);测定各组病人CRP、PCT、IL-6、TNF-α和sPDPN等指标。结果sPDPN及CRP、PCT、IL-6、TNF-α水平和SOFA、APACHEⅡ评分在脓毒症肺损伤组、脓毒症组和对照组间,及各亚组间差异均具有统计学意义(P<0.05)。在各组别中,sPDPN与上述炎症指标、EVLW、SOFA评分及APACHEⅡ评分均呈正相关(P<0.05)。sPDPN预测病人28 d转归的ROC曲线下的AUC为0.867。结论在老年脓毒症病人发生ARDS时的早期诊断、病情分级和预后评估以及可能的治疗靶点选择方面,sPDPN是一个具有潜在价值的靶点。Objective To study the clinical value of plasma soluble podoplanin(sPDPN)in the early diagnosis,severity and prognosis evaluation foRthe elderly patients with septic lung injury.Methods A total of 95 elderly patients with sepsis admitted to Department of ICU,Wuxi People’s Hospital from January 2018 to DecembeR2020 were selected and divided into sepsis group(n=40)and septic lung injury group(n=55).The patients in the septic lung injury group were subdivided into sepsis combined with acute respiratory distress syndrome(ARDS)subgroup(n=29)and septic shock combined with ARDS subgroup(n=26)according to the severity of the complications,and were subdivided into survival subgroup(n=40)and death subgroup(n=15)according to the 28-d outcome.Thirty healthy subjects from physical examination centeRof ouRhospital during the same period were enrolled in control group.The general condition,APACHEⅡscore,SOFA score and extravasculaRlung water(EVLW)were observed and recorded,and the levels of C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),tumoRnecrosis factor-α(TNF-α)and sPDPN were detected on the day of admission to ICU.Results The expression level of sPDPN,the levels of CRP,PCT,IL-6 and TNF-α,SOFA score and APACHEⅡscore showed statistical differences among all the groups and subgroups(P<0.05).The level of sPDPN was positively correlated with the above inflammatory indexes,EVLW,SOFA score and APACHEⅡscore in each group.The area undeRthe curve(AUC)of receiveRoperatoRcharacteristic(ROC)of sPDPN in predicting the outcome of the septic lung injuny patients was 0.867.Conclusions sPDPN is a potentially valuable target foRearly diagnosis,evaluation of disease condition and prognosis,and selection of possible therapeutic targets in the patients with sepsis combined with acute lung injury.

关 键 词：脓毒症 肺损伤 平足蛋白 炎症反应 巨噬细胞 

分 类 号：R459.7[医药卫生—急诊医学]