早期脓毒症合并ARDS患者EVLWI，Ang2，vWF与新柏林分级及预后评价的探讨

发布时间：2018-01-07 17:32

本文关键词：早期脓毒症合并ARDS患者EVLWI，Ang2，vWF与新柏林分级及预后评价的探讨　出处：《郑州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的评价血管外肺水指数(EVLWI)结合Ang-2、v WF,与早期脓毒症合并急性呼吸窘迫综合征(ARDS)患者的柏林标准严重程度分级的相关性,探讨对疾病严重程度及预后评估的应用价值。方法回顾性分析2013年1月至2014年6月入住郑州大学第一附属医院重症医学科的41例行脉搏指示持续心排血量(Pi CCO)监测的早期脓毒症合并ARDS患者的临床资料,并根据入科时氧合指数(Pa O2/Fi O2)分为轻度、中度、重度三组,观测的终点指标为28天死亡率,按28天预后分为存活组及死亡组。所有患者均于入重症加强治疗病房(ICU)起始0时、第1天、第2天、第3天时采用Pi CCO检测仪监测EVLWI,用酶联免疫吸附试验(ELISA)检测上述同一时间点的血浆Ang-2、v WF水平;记录入选时的患者一般资料和机械通气时间及住ICU时间;计算急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭评分(SOFA);比较生存组和死亡组ARDS患者EVLWI、Ang-2、v WF指标间差异;对这些指标和氧合指数进行相关性分析;绘制受试者工作特征曲线(ROC),评价各指标对预后的价值。结果共回顾性收集41例早期脓毒症合并ARDS患者,28 d存活22例,死亡19例。死亡组除APACHEⅡ、EVLWI、Ang-2评分均明显高于存活组(均P0.01),ICU住院时间明显短于存活组外,其他基线资料如性别、年龄、感染来源、机械通气时间与存活组比较差异均无统计学意义(P0.05)。随治疗时间延长,存活组EVLWI逐渐下降,死亡组逐渐升高;死亡组入ICU 0、1、2、3 d时EVLWI均明显高于存活组〔EVLWI(ml/kg)0d:13.67±6.16比9.82±2.81,t=3.324,P=0.038;1 d:14.05±6.29比9.13±2.70,t=3.732,P=0.032;2 d:14.58±6.89比8.82±2.40,t=4.738,P=0.001;3 d:15.32±6.71比7.50±1.95,t=5.225,P=0.000〕。两组血浆Ang-2水平均先升后降,死亡组入ICU 0、1、2、3 d时血浆Ang-2水平均明显高于存活组〔Ang-2(ng/L)0 d:402.41±227.54比259.47±153.52,t=4.879,P=0.000;1 d:409.36±212.31比279.22±140.83,t=4.138,P=0.014;2d:439.72±207.56比318.76±168.65,t=3.327,P=0.038;3 d:425.66±204.89比302.94±167.04,t=3.979,P=0.022〕。两组血浆v WF水平均逐渐上升,死亡组入ICU 0、1、2、3 d时血浆v WF数值均高于存活组,但无统计学差异〔v WF(U/L)0 d:615.72±603.14比527.75±576.59,t=0.807,P=0.543;1 d:602.53±553.20比515.04±689.15,t=0.789,P=0.625;2 d:799.06±842.15比718.31±762.67,t=0.837,P=0.492;3 d:841.62±782.93比806.95±610.49,t=0.911,P=0.461〕。入ICU 0d时,各个指标均没有相关性(均P0.05)。入ICU1、2、3 d时Ang-2与EVLWI均呈显著正相关(r1=0.605、r2=0.458、r3=0.392,1、2d均P0.01,3d P0.05)。入ICU 1、2、3d时Ang-2与Pa O2/Fi O2均呈负相关(r1=-0.656、r2=-0.429、r3=-0.354,均P0.01,3d P0.05),EVLWI与Pa O2/Fi O2均呈负相关(r1=-0.739、r2=-0.473、r3=-0.388,均P0.01)。入ICU1、2、3 d时v WF与Pa O2/Fi O2无明显相关性(r1=-0.107、r2=0.075、r3=0.345,均P0.05)。ROC曲线分析显示,入ICU 1 d时Ang-2的ROC曲线下面积(AUC)为0.778±0.075,截断值为315.15ng/L时,评估预后的敏感度为84.21%,特异度为68.18%;入ICU 3 d时EVLWI的AUC为0.818±0.068,截断值为12.5 m L/kg时,评估预后的敏感度为63.16%,特异度为95.45%;二者的预后评估价值均优于同时间点APACHEⅡ、SOFA评分。1 d时Ang-2联合EVLWI的AUC为0.844±0.064,截断值为0.483时,评估预后的敏感度为88.42%,特异度为90.91%;入ICU 3 d时Ang-2联合EVLWI的AUC为0.828±0.066,截断值为0.646时,评估预后的敏感度为84.65%,特异度为95.45%,二者均较其他单独评价指标具有更好的预后评估价值(均P0.01)。结论Ang-2可作为早期脓毒症合并ARDS的一个实用的血清学指标,EVWLI和Ang-2与柏林分级呈负相关性,v WF因子与柏林分级无相关性,Ang-2与EVLWI呈明显正相关,Ang-2与EVLWI联合可为临床早期评估脓毒症合并ARDS患者的病情及预测预后、并针对高危患者积极进行干预治疗提供参考。
[Abstract]:Extravascular lung water index (EVLWI) combined with Ang-2, V WF, and the early stage of sepsis with acute respiratory distress syndrome (ARDS) patients in Berlin relative grade standard severity, investigate the application value of assessment of disease severity and prognosis. Methods Retrospective analysis indicates continuous cardiac output in ICU. The First Affiliated Hospital of Zhengzhou University from January 2013 to June 2014 in the 41 patients who received pulse (Pi CCO) clinical data monitoring early sepsis in patients with ARDS, and according to the Department of oxygenation index (Pa O2/Fi O2) were divided into mild, moderate and severe group three, end point indicators observed for 28 day mortality, according to 28 days the prognosis is divided into survival group and death group. All patients in the ICU (ICU) starting at 0, first days, second days, third days when using the Pi CCO tester monitoring EVLWI by enzyme-linked immunosorbent assay (ELISA) detection of the above The plasma levels of Ang-2 at the same time, the level of WF V; records selected when the general data of patients and the duration of mechanical ventilation and ICU stay; and chronic health evaluation II calculation of acute physiology (APACHE II) and sequential organ failure assessment score (SOFA); to compare the survival group and death group of patients with ARDS EVLWI Ang-2. V WF, the difference between the index and the index; oxygenation index correlation analysis; receiveroperating characteristic curve (ROC), to evaluate the value of each index on the prognosis. Results of 41 cases of patients with early sepsis in patients with ARDS were reviewed, 28 d 22 cases survived, 19 cases died. The death group in addition to APACHE II, EVLWI, Ang-2 scores were significantly higher than the survival group (P0.01), ICU hospitalization time was significantly shorter than the survival group, other baseline data such as gender, age, source of infection, the difference of mechanical ventilation time and survival group had no statistical significance (P0.05) with the treatment. Prolonged survival group EVLWI decreased gradually, the death group increased gradually; the death group 0,1,2,3 into ICU D EVLWI were significantly higher than the survival group, EVLWI (ml/kg) 0d:13.67 + 6.16 to 9.82 + 2.81, t=3.324, P=0.038; 1 d:14.05 + 6.29 9.13 + 2.70, t=3.732, P=0.032; 2 d:14.58 + 6.89 + 8.82 2.40, t=4.738, P=0.001; 3 d:15.32 + 6.71 to 7.50 + 1.95, t=5.225, P=0.000. The plasma Ang-2 levels of the two groups were decreased, the death group ICU 0,1,2,3 d into the plasma level of Ang-2 was higher than the survival group, Ang-2 (ng/L) d:402.41 0 + 227.54 to 259.47 + 153.52, t=4.879, P=0.000; 1 d:409.36 + 212.31 to 279.22 + 140.83, t=4.138, P=0.014; 2d:439.72 + 207.56 to 318.76 + 168.65, t=3.327, P=0.038; 3 d:425.66 + 204.89 302.94 + 167.04, t=3.979, P=0.022. The plasma V WF levels of the two groups were gradually increased, the death group into the ICU D 0,1,2,3 data of the plasma V WF was higher than that of the survival group, But there was no significant difference in V WF (U/L) d:615.72 0 + 603.14 to 527.75 + 576.59, t=0.807, P=0.543; 1 d:602.53 + 553.20 515.04 + 689.15, t=0.789, P=0.625; 2 d:799.06 + 842.15 718.31 + 762.67, t=0.837, P=0.492; 3 d:841.62 + 782.93 to 806.95 + 610.49, t= 0.911, P=0.461. In ICU 0d, each index had no correlation (P0.05). ICU1,2,3 D Ang-2 was positive correlated with EVLWI (r1=0.605, r2=0.458, r3=0.392,1,2d P0.01,3d P0.05 ICU 1,2,3d). In Ang-2 and Pa O2/Fi O2 were negatively correlated (r1=-0.656, R2, =-0.429, r3=-0.354, P0.01,3d, P0.05) there was negative correlation between EVLWI and Pa O2/Fi O2 (r1=-0.739, r2=-0.473, r3=-0.388, P0.01). D WF and V ICU1,2,3 Pa O2/Fi O2 had no significant correlation (r1=-0.107, r2=0.075, r3=0.345, P0.05).ROC curve analysis showed that the area of 1 ROC d into the ICU curve under Ang-2 (AUC) 0.778 + 0.075, The cut-off value of 315.15ng/L, the prognostic sensitivity was 84.21%, specificity was 68.18%; ICU 3 D EVLWI AUC was 0.818 + 0.068, the cut-off value of 12.5 m L/kg, the prognostic sensitivity was 63.16%, specificity was 95.45%; prognostic value of two were superior to the time point APACHE II, SOFA.1 D Ang-2 combined with EVLWI score AUC was 0.844 + 0.064, when the cutoff value was 0.483, the prognostic sensitivity was 88.42%, specificity was 90.91%; ICU 3 D Ang-2 AUC combined with EVLWI was 0.828 + 0.066, when the cutoff value was 0.646, the sensitivity of prognostic evaluation 84.65%, the specificity was 95.45%, prognostic value was higher than that of the other two individual evaluation indexes are better (P0.01). Conclusion Ang-2 can be used as a useful serological index of early sepsis with ARDS, EVWLI and Ang-2 in Berlin and there was a negative correlation between V grading, WF grading and Berlin related factor Sex, Ang-2 and EVLWI were positively correlated. Ang-2 and EVLWI combination can be used for early clinical evaluation of sepsis and ARDS patients' condition and prognosis, and provide reference for high-risk patients with active intervention.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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