血清生物标志物对重症社区获得性肺炎患者发生急性呼吸窘迫综合征及28 d预后的预测价值  

Predictive value of serum biomarkers on acute respiratory distress syndrome and 28 d prognosis in patients with severe community-acquired pneumonia

作　　者：吴旭[1] 宋元林[1,2] 胡莉娟 WU Xu;SONG Yuan-lin;HU Li-juan(Department of Respiratory and Critical Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Key Laboratory of Pulmonary Inflammation and Injury,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院呼吸与危重症医学科,上海200032 [2]上海市肺部炎症与损伤重点实验室,上海200032

出　　处：《中国临床医学》2023年第4期599-604,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(82000095,82070075);国家重点研发计划(2020YFC2003700).

摘　　要：目的探讨重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)患者的血清生物标志物对其发生急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的预测效能。方法选择2019年1月至2021年3月复旦大学附属中山医院呼吸与危重症医学科监护室收治的53例SCAP患者,根据入院7 d内是否发生ARDS将其分为ARDS组(n=24)和non-ARDS组(n=29)。比较两组患者基本信息、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、肺炎严重程度指数(pneumonia severity index,PSI)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、氧合指数、实验室检查指标水平及28 d死亡率。采用ELISA检测患者血清白介素6(interleukin-6,IL-6)、IL-1β、血清肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、IL-10、1-磷酸鞘氨醇(sphingosine-1-phosphate,S1P)、血管生成素2(angiopoietin-2,Ang-2)及血管性血友病因子(von Willebrand factor,vWF)等指标水平。采用logistic回归模型分析发生ARDS的独立危险因素,并绘制ROC曲线评估各因子的预测价值。结果两组患者的APACHEⅡ评分、SOFA评分、C反应蛋白、降钙素原、有创机械通气使用率、28 d死亡率差异无统计学意义。与non-ARDS组比较,ARDS组患者血清IL-6、vWF水平显著升高(P<0.05),S1P水平降低(P<0.05)。Logistic回归分析显示,vWF(OR=1.017,P=0.010)、IL-6(OR=1.087,P=0.020)及氧合指数(OR=0.983,P=0.039)升高是发生ARDS的独立危险因素。vWF、IL-6预测ARDS的曲线下面积(AUC)分别为0.881和0.749,最佳截断值分别为296.1%和32.35μg/L。结论IL-6、vWF升高对SCAP患者发生ARDS有一定预测价值。Objective To explore the predictive value of the serum biomarkers on acute respiratory distress syndrome(ARDS)in patients with severe community-acquired pneumonia(SCAP).Methods A total of 53 SCAP patients admitted to the respiratory intensive care unit(RICU)of Zhongshan Hospital,Fudan University from January 2019 to March 2021 were selected,and were divided into ARDS group(n=24)and non-ARDS group(n=29)according to the occurrence of ARDS within 7 days after admission.Demographic information,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,pneumonia severity index(PSI),sequential organ failure assessment(SOFA)score,oxygenation index,laboratory data levels and 28-day mortality were compared between the two groups.Serum interleukin(IL)-6,IL-1β,tumor necrosis factor-α(TNF-α),IL-10,sphingosine-1-phosphate(S1P),angiopoietin-2(Ang-2)and von Willebrand factor(vWF)were detected by ELISA.The logistic regression was used to analyzed independent risk factors of ARDS,and ROC curve was used to estimate the predictive value of each factor.Results There was no significant difference in APACHEⅡscore,SOFA score,C-reactive protein(CRP),procalcitonin(PCT),rate of mechanical ventilation and 28-day mortality between the two groups.Compared with non-ARDS group,the serum levels of IL-6 and vWF were significantly increased,while S1P was significantly decreased in ARDS group(P<0.05).The logistic regression analysis showed that vWF(OR=1.017,P=0.010),IL-6(OR=1.087,P=0.020)and oxygenation index(OR=0.983,P=0.039)were independent risk factors for ARDS.The area under the curve(AUC)of vWF and IL-6 predicting ARDS was 0.881 and 0.749,and the cut-off values were 296.1%and 32.35μg/L,respectively.Conclusions IL-6 and vWF can predict the occurrence of ARDS in patients with SCAP.

关 键 词：重症社区获得性肺炎 急性呼吸窘迫综合征 细胞因子 炎症反应 

分 类 号：R563[医药卫生—呼吸系统]