血清AGEs水平联合LIS对老年脓毒症相关性ALI/ARDS患者预后的评估价值  

Evaluation value of serum AGEs level combined with LIS score on prognosis of elderly patients with sepsis-related ALI/ARDS

作　　者：邹谧 潘静[2] 周平[2] 陈巧 李偲 李世颖[3] ZOU Mi;PAN Jing;ZHOU Ping;CHEN Qiao;LI Cai;LI Shiying(Department of Respiratory Medicine,First Branch of the First Affiliated Hospital of Chongqing Medical University,Chongqing 400015,China;Department of Geriatrics,First Branch of the First Affiliated Hospital of Chongqing Medical University,Chongqing 400015,China;Department of Infectious Diseases,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第一医院第一分院呼吸科,重庆400015 [2]重庆医科大学附属第一医院第一分院老年科,重庆400015 [3]重庆医科大学附属第二医院感染科,重庆400010

出　　处：《国际检验医学杂志》2024年第2期129-133,共5页International Journal of Laboratory Medicine

基　　金：国家青年科学基金项目(81801990)。

摘　　要：目的探究老年脓毒症相关性急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者肺损伤评分(LIS)及晚期糖基化终末产物(AGEs)水平对预后的评估价值。方法选择重庆医科大学附属第一医院第一分院于2019年3月至2021年4月收治的98例老年脓毒症相关性ALI/ARDS患者作为研究组,根据患者入院后30 d内的生存情况将患者分为存活组(55例)和死亡组(43例),另选取51例重庆医科大学附属第一医院第一分院同期收治的非ALI/ARDS脓毒症老年患者作为对照组。患者入院后,记录患者临床资料,检测患者血肌酐、肌钙蛋白Ⅰ、B型脑肽钠(BNP)、C反应蛋白(CRP)、降钙素原(PCT)水平。采用酶联免疫吸附试验测定患者血清中AGEs水平。采用LIS量表计算LIS得分。以患者临床因素作为自变量,患者预后结局作为因变量,采用Logistic回归曲线对老年脓毒症相关性ALI/ARDS患者死亡因素进行多因素分析。结果死亡组、存活组、对照组AGEs水平、LIS得分、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分依次降低(均P<0.05)。死亡组动脉血乳酸、血糖、肌钙蛋白Ⅰ、PCT、BNP、CRP水平均高于存活组和对照组(P<0.05)。结果显示,动脉血乳酸、血糖、肌钙蛋白Ⅰ、PCT、BNP、CRP、AGEs、APACHEⅡ评分、LIS得分均是老年脓毒症相关性ALI/ARDS患者死亡的独立危险因素(P<0.05)。LIS得分预测老年脓毒症相关性ALI/ARDS患者预后的曲线下面积(AUC)为0.857(95%CI:0.821~0.911),血清AGEs的AUC为0.861(95%CI:0.809~0.908),LIS得分和AGEs水平对老年脓毒症相关性ALI/ARDS患者预后均具有一定的预测价值。结论老年脓毒症相关性ALI/ARDS患者LIS得分及AGEs水平均是患者死亡的独立危险因素,对预后有重要的预测价值。Objective To study the evaluation value of lung injury score(LIS)and advanced glycation end products(AGEs)expression levels on the prognosis of elderly patients with sepsis-related acute lung injury/acute respiratory distress syndrome(ALI/ARDS).Methods A total of 98 elderly patients with sepsis-related ALI/ARDS admitted to First Branch of the First Affiliated Hospital of Chongqing Medical University from March 2019 to April 2021 were selected as the research group,and the patients were divided into two subgroups according to their survival within 30 d after admission:the survival group(55 cases)and the death group(43 cases).Another 51 elderly patients with non-ALI/ARDS sepsis admitted to First Branch of the First Affiliated Hospital of Chongqing Medical University in the same period were selected as the control group.After admission,the clinical data of patients were recorded,and the levels of serum creatinine,troponin I,B-type brain natriuretic peptide(BNP),serum C-reactive protein(CRP)and procalcitonin(PCT)were detected.Enzyme-linked immunosorbent assay was used to determine the levels of AGEs in patients′serum.The LIS score was evaluated by LIS scale.With clinical factors as independent variables and prognosis as dependent variables,Logistic regression curve was used to analyze the death factors of elderly sepsis-related ALI/ARDS patients.Results AGEs levels,LIS scores,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores decreased sequentially in the death group,survival group,and control group(all P<0.05).The levels of lactic acid,blood glucose,troponin I,PCT,BNP and CRP in arterial blood of patients in the death group were significantly higher than those in the survival group and the control group(P<0.05).The results showed that arterial lactate,blood glucose,troponin I,PCT,BNP,CRP,AGEs,APACHEⅡscore,and LIS score were all independent risk factors for mortality in elderly sepsis-related ALI/ARDS patients(P<0.05).The area under the curve(AUC)of LIS score predicting prognosis in elderly sepsis

关 键 词：脓毒症 急性肺损伤 急性呼吸窘迫综合征 肺损伤评分 晚期糖基化终末产物 

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