血清学生物标志物对急性呼吸窘迫综合征进展及预后的预测研究

发布时间：2018-03-03 03:07

本文选题：急性呼吸窘迫综合征　切入点：早期诊断　出处：《第三军医大学学报》2017年19期 　论文类型：期刊论文

【摘要】：目的探讨血清学生物标志物对急性呼吸窘迫综合征(ARDS)早期诊断预警及预后判断的预测效果。方法采用多中心、前瞻队列研究的方法,从2014年1月开始纳入各中心收治的ARDS与ARDS高危病例。采集患者的人口学资料,检测患者在入组24 h内的血清学指标(sRAGE、CC16、Ang-2、sICAM-1、PAI-1、Su PAR、HMGB1)。采用Logistic回归分析对影响高危ARDS患者发展成为ARDS危险因素和影响ARDS预后的危险因素。用ROC曲线比较单个危险因素或联合多个危险因素对ARDS发生的预警及ARDS死亡预后的预测效果,计算其预测的灵敏度、特异度及约登指数。结果共纳入ARDS患者59例,ARDS高危患者41例。ARDS发生的独立危险因素有HMGB1、sICAM-1、Ang-2、CC16、PAI-1。其中HMGB1预测效果最好(AUC=0.908),其次根据AUC大小顺序为CC16(AUC=0.861),Ang-2(AUC=0.858),PAI-1(AUC=0.801),sICAM-1(AUC=0.773)。单指标分析中,敏感度最高的单指标为HMGB1与sICAM-1,皆为79.7%,特异度最高的指标为HMGB1、CC16与Ang-2,皆为87.8%。在联合预测中,HMGB1与Ang-2联合预测,特异度最高,为95.1%,其AUC也为最高(0.92)。HMGB1、Ang-2与PAI-1指标联合预测,敏感度最高,为89.9%。多指标联合预测,可以在一定程度上提高对ARDS诊断预测的灵敏度和特异度。对ARDS预后分析,sRAGE与Ang-2是其死亡的独立危险因素。sRAGE(AUC=0.791)比Ang-2(AUC=0.67)对ARDS患者死亡预测效果好。两指标联合可以提高ARDS死亡预测的特异性。结论在ARDS高危患者中,HMGB1、sICAM-1、Ang-2、CC16、PAI-1是其发展成为ARDS的独立危险因素。HMGB1与Ang-2联合预测有较好的特异性,HMGB1、Ang-2与PAI-1联合预测有较好的敏感性。对于ARDS患者,sRAGE与Ang-2的增高预示着ARDS患者预后不良,两者联合预测可以提高预测的特异性。
[Abstract]:Objective to investigate the predictive effect of serological biomarkers on early diagnosis, early warning and prognosis of ARDS patients with acute respiratory distress syndrome (ARDS). Since January 2014, the high risk cases of ARDS and ARDS have been admitted into the centers. The demographic data of the patients have been collected. The serum markers of sRAGECC16 / Ang-2SICAM-1 / PAI-1 / Su PARN HMGB1 were detected within 24 hours after entering the group. Logistic regression analysis was used to analyze the risk factors affecting the development of ARDS and the prognosis of ARDS in high-risk ARDS patients. The single risk factor or combination was compared with ROC curve. To predict the occurrence of ARDS and the prognosis of ARDS death. Results the independent risk factors were HMGB1sICAM-1 / Ang-2CC16PAI-1in 59 ARDS patients with high risk of ARDS. Among them, the best prediction effect of HMGB1 was 0.908, and the next was the order of AUC size: CC16AM-0.861Ag-2AUCY 0.858A PAI-0.801AM-1AM-1AUC0.773. The single index with the highest sensitivity is HMGB1 and sICAM-1, both of which are 79.7, and the highest specificity is HMGB1, CC16 and Ang-2, both of which are 87.8. In the joint prediction, the specificity of HMGB1 and Ang-2 is the highest (95.1), and its AUC is the highest 0.92. HMGB1Ang-2 combined with PAI-1, and the sensitivity is the highest. For 89.9. multiple index joint prediction, To a certain extent, the sensitivity and specificity of diagnosis and prediction of ARDS could be improved. The prognostic analysis of ARDS: sRAGE and Ang-2 are independent risk factors of death. SRAGEG AUC 0.791) is better than Ang-2AUC 0.67 in predicting the death of ARDS patients. The combination of the two indexes can improve the effect of ARDS. Conclusion HMGB1 / sICAM-1 / Ang-2CC16PAI-1 is an independent risk factor for the development of ARDS. HMGB1 combined with Ang-2 has a better specificity for combined prediction of HMGB1Ang-2 and PAI-1, and is more sensitive to sRAGE and Ang-2 in ARDS patients. The increase in ARDS indicates that the prognosis of patients with ARDS is poor. Combined prediction can improve the specificity of prediction.
【作者单位】：第三军医大学新桥医院呼吸科全军呼吸内科研究所;第三军医大学西南医院急诊科;第三军医大学大坪医院野战外科研究所重症监护室;
【基金】：军队“十二五”医学科研重点项目(BWS12J035)~~
【分类号】：R563.8

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