血清eNAMPT、sDR5在脓毒症相关急性呼吸窘迫综合征患者中的表达及临床意义  

Expression and clinical significance of peripheral blood eNAMPT and sDR5 in patients with sepsis-associated acute respiratory distress syndrome

作　　者：姜少雄 夏义琴[1] 刘立鹏 朱晓林 蔡彬蓉 申静 Jiang Shaoxiong;Xia Yiqin;Liu Lipeng;Zhu Xiaolin;Cai Binrong;Shen Jing(Department of Emergency,West China Hospital of Sichuan University,Sichuan,Chengdu 610041,China)

机构地区：[1]四川大学华西医院急诊科,成都610041

出　　处：《疑难病杂志》2025年第4期391-396,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：四川省卫生健康科研课题(19PJ237)。

摘　　要：目的探讨血清细胞外烟酰胺磷酸核糖基转移酶(eNAMPT)、可溶性死亡受体5(sDR5)在脓毒症相关急性呼吸窘迫综合征(SA-ARDS)患者中的表达及临床意义。方法选取2021年1月—2024年7月四川大学华西医院急诊科收治的SA-ARDS患者205例作为SA-ARDS组,同期医院健康体检志愿者114例为健康对照组,SA-ARDS患者根据病情程度分为轻度亚组62例、中度亚组74例、重度亚组69例,根据28 d预后分为死亡亚组80例和存活亚组125例。采用酶联免疫吸附法检测血清eNAMPT、sDR5水平;采用Spearman相关分析SA-ARDS患者血清eNAMPT、sDR5水平与氧合指数的相关性;多因素Logistic回归分析血清eNAMPT、sDR5水平与SA-ARDS患者死亡的关系;受试者工作特征(ROC)曲线分析血清eNAMPT、sDR5水平对其的评估效能。结果与健康对照组比较,SA-ARDS组血清eNAMPT、sDR5水平升高(t/P=14.006/<0.001、19.931/<0.001);轻度亚组、中度亚组、重度亚组血清eNAMPT、sDR5水平依次升高(F/P=97.467/<0.001、157.287/<0.001);SA-ARDS患者血清eNAMPT、sDR5水平与氧合指数呈负相关(r/P=-0.724/<0.001、-0.720/<0.001);入住监护室时间延长、机械通气时间≥3 d、序贯器官衰竭评估(SOFA)评分高、急性生理和慢性健康评估Ⅱ(APACHEⅡ)评分高、eNAMPT高、sDR5高为SA-ARDS患者死亡的独立危险因素[OR(95%CI)=1.221(1.028~1.449)、3.111(1.207~8.020)、1.270(1.064~1.517)、1.093(1.025~1.167)、1.104(1.054~1.157)、1.030(1.015~1.046)],氧合指数高为独立保护因素[OR(95%CI)=0.989(0.982~0.996)];血清eNAMPT、sDR5水平及二者联合评估SA-ARDS患者死亡的曲线下面积分别为0.794、0.780、0.877,二者联合大于eNAMPT、sDR5水平单独评估的AUC(Z/P=2.150/0.032、2.273/0.023)。结论SA-ARDS患者血清eNAMPT、sDR5水平升高,与病情程度加重和死亡密切相关,血清eNAMPT、sDR5水平联合评估SA-ARDS患者死亡的效能较高。Objective To investigate the expression and clinical significance of extracellular nicotinamide phosphoribosyl transferase(eNAMPT)and soluble death receptor 5(sDR5)in patients with sepsis-associated acute respiratory distress syndrome(SA-ARDS).Methods A total of 205 SA-ARDS patients admitted to the Emergency Department of West China Hospital,Sichuan University from January 2021 to July 2024 were selected as the SA-ARDS group,and 114 healthy volunteers from the hospital's health check-up center were selected as the healthy control group.Based on the severity of the disease,the SA-ARDS patients were divided into three subgroups:mild SA-ARDS(62 cases),moderate SA-ARDS(74 cases),and severe SA-ARDS(69 cases).According to the 28-day prognosis,they were further divided into the death subgroup(80 cases)and survival subgroup(125 cases).Serum eNAMPT and sDR5 levels were detected by enzyme-linked immunosorbent assay.Spearman correlation analysis was performed to assess the correlation between serum eNAMPT,sDR5 levels,and the oxygenation index in SA-ARDS patients.Multivariate unconditional logistic regression analysis was used to examine the relationship between serum eNAMPT,sDR5 levels,and mortality in SA-ARDS patients.The diagnostic performance of serum eNAMPT and sDR5 levels was evaluated by receiver operating characteristic(ROC)curve analysis.Results Compared with the healthy control group,serum eNAMPT and sDR5 levels in the SA-ARDS subgroups were significantly elevated(t/P=14.006/<0.001,19.931/<0.001).Serum eNAMPT and sDR5 levels increased progressively in the mild,moderate,and severe SA-ARDS subgroups(F/P=97.467/<0.001,157.287/<0.001).Serum eNAMPT and sDR5 levels were negatively correlated with the oxygenation index(r/P=-0.724/<0.001,-0.720/<0.001).Prolonged intensive care unit(ICU)stay,mechanical ventilation≥3 days,high Sequential Organ Failure Assessment(SOFA)score,high Acute Physiology and Chronic Health Evaluation II(APACHE II)score,elevated eNAMPT and sDR5 levels were identified as independent risk factors for m

关 键 词：脓毒症 急性呼吸窘迫综合征 细胞外烟酰胺磷酸核糖基转移酶 可溶性死亡受体5 病情程度 预后 

分 类 号：R631[医药卫生—外科学] R563.9[医药卫生—临床医学]