评价经肺动脉导管检测游离脂肪酸对重症肺炎并发肺脂肪栓塞综合征早期诊断的价值  

Evaluation of the value of free fatty acid detection via pulmonary artery catheter in the early diagnosis of pulmonary fat embolism syndrome complicated with severe pneumonia

作　　者：董琦 尚益如 王健楠 富奇志[1] DONG Qi;SHANG Yiru;WANG Jiannan;FU Qizhi(The First Affiliated Hospital,College of Clinical Medicine of Henan University of Science and Technology,Luoyang,Henan 471003,China;The First Bethune Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]河南科技大学临床医学院河南科技大学第一附属医院,河南洛阳471003 [2]吉林大学白求恩第一医院,吉林长春130021

出　　处：《中国实验诊断学》2025年第4期401-405,共5页Chinese Journal of Laboratory Diagnosis

基　　金：国家卫生健康委医药卫生科技发展研究中心中国初级卫生保健基金会(MTP2022D030)。

摘　　要：目的旨在深入探究经肺动脉导管(pulmonary artery catheter,PAC)检测游离脂肪酸(free fatty acids,FFAs)对重症肺炎患者输注脂肪乳后并发肺脂肪栓塞综合征(fat embolism syndrome,FES)早期诊断的实际价值。方法研究对象为在2021年8月至2023年8月因重症肺炎需行机械通气而入住重症监护室的患者,并对患者的病案资料进行回顾性搜集。入选的患者要求建立PAC前已连续输注中/长链脂肪乳注射液大于5 d,总共入选患者134例。肺FES的诊断主要采用Gurd和Wilson建立的FES诊断标准,依据住院期间是否发生肺FES事件分为FES组(n=16)及对照组(n=118)。描述两组研究对象的基本信息特征采用描述性统计分析,统计两组PAC局部肺动脉血液中FFAs浓度的组间差异采用独立样本t检验,使用Logistic回归模型来评估FFAs浓度与肺FES临床关联性并调整可能的混杂因素,通过构建接受者操作特征曲线(receiver operating characteristic curve,ROC)来评估经PAC化验的FFAs在肺FES早期诊断中的诊断性能,计算ROC曲线下的面积以及敏感性、特异性、阳性预测值和阴性预测值。结果在本研究中,重症肺炎行机械通气患者输注脂肪乳后肺FES整体发生率为11.94%。FES组与对照组经PAC化验血液FFAs浓度差异有统计学意义(P<0.001),且FES组FFAs浓度显著高于对照组[(2.59±0.41)mmol/L vs(1.53±0.46)mmol/L],组间差异具有显著统计学意义(OR=1.057,95%CI:0.825~1.288,P<0.001)。氧合指数(PaO_(2)/FiO_(2))≤200 mmHg、APACHEⅡ评分≥15分、局部肺动脉血液FFAs浓度是重症肺炎行机械通气患者输注脂肪乳后并发肺FES事件的独立危险因素。经PAC检测血液FFAs浓度预测FES效能为0.975(95%CI:0.970~0.980),灵敏度1.000,特异性0.923,约登指数为0.923,最佳截断值为2.065 mmol/L,该预测效能远高于氧合指数(PaO_(2)/FiO_(2))≤200 mmHg(AUC=0.620,95%CI:0.579~0.661)及APACHEⅡ评分≥15分(AUC=0.728,95%CI:0.689~0.767)所对应的预测效能。Objective This study aimed to evaluate the actual value of detecting free fatty acids(FFAs)through pulmonary artery catheter(PAC)in the early diagnosis of pulmonary fat embolism syndrome(FES)in patients with severe pneumonia who received fat emulsion infusion.Methods The study subjects were patients with severe pneumonia who required mechanical ventilation and were admitted to the intensive care unit from August 2021to August 2023.The retrospective collection of their medical records was conducted.The patients selected for the study had been continuously infused with medium/long-chain fat emulsion injection for more than 5days before the PAC was established.A total of 134patients were enrolled.The diagnosis of pulmonary fat embolism syndrome(FES)was mainly based on the diagnostic criteria of FES established by Gurd and Wilson.According to whether pulmonary FES events occurred during hospitalization,the patients were divided into the FES group(n=16)and the control group(n=118).Descriptive statistical analysis was used to describe the basic information features of the two groups of research subjects,and the independent sample t-test was employed to statistically compare the inter-group differences in the concentration of FFAs in the local pulmonary artery blood of the two groups.A logistic regression model was used to assess the clinical association between FFAs concentrations and pulmonary FES,adjusting for possible confounding factors.The diagnostic performance of FFAs in pulmonary FES early diagnosis through PAC testing was evaluated by constructing the receiver operating characteristic(ROC)curve and assessing the area under the ROC curve(AUC),sensitivity,specificity,positive predictive value,and negative predictive value.Results The results showed that the overall incidence of pulmonary FES after intravenous fat emulsion infusion in patients undergoing mechanical ventilation for severe pneumonia was 11.94%.There was a significant difference in FFAs concentration between the FES group and the control group after

关 键 词：脂肪栓塞综合征 游离脂肪酸 重症肺炎 肺动脉导管 

分 类 号：R563.1[医药卫生—呼吸系统]