浏览全部资源
扫码关注微信
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
Predictive values of serological biomarkers in progress and prognosis of acute respiratory distress syndrome
- 第三军医大学学报 2017年39卷第19期 页码：1926-1932
- 作者机构：
1.400037 重庆，第三军医大学新桥医院呼吸科，全军呼吸内科研究所
2.400038 重庆，第三军医大学西南医院急诊科
3.400042 重庆，第三军医大学大坪医院野战外科研究所重症监护室
- 作者简介：
[ 王长征，E-mail：czwang@netease.com WANG Chang-zheng, E-mail:czwang@netease.com
- 基金信息：军队"十二五"医学科研重点项目(BWS12J035)
DOI：10.16016/j.1000-5404.201703114
中图分类号： R181.32;R446.11;R563.8收稿：2017-03-19，
修回：2017-07-18，
纸质出版：2017-10-15
- 稿件说明：
移动端阅览
王冉, 张巧, 马千里, 等. 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[J]. 第三军医大学学报, 2017,39(19):1926-1932.
Ran WANG, Qiao ZHANG, Qianli MA, et al. Predictive values of serological biomarkers in progress and prognosis of acute respiratory distress syndrome[J]. Journal of Third Military Medical University, 2017, 39(19): 1926-1932.
王冉, 张巧, 马千里, 等. 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[J]. 第三军医大学学报, 2017,39(19):1926-1932. DOI： 10.16016/j.1000-5404.201703114.
Ran WANG, Qiao ZHANG, Qianli MA, et al. Predictive values of serological biomarkers in progress and prognosis of acute respiratory distress syndrome[J]. Journal of Third Military Medical University, 2017, 39(19): 1926-1932. DOI： 10.16016/j.1000-5404.201703114.
摘要
目的
2
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
2
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、SuPAR、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
2
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
2
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
2
To investigate the predictive effect of serological biomarkers in early diagnosis and prognosis of acute respiratory distress syndrome (ARDS).
Methods
2
A multicenter
prospective cohort study was conducted from January 2014 to enroll ARDS cases and cases at high risk of ARDS in each center. The patients' demographic data were collected and the serological biomarkers
including soluble receptor of advanced glycosylation end products (sRAGE)
Clara cell protein (CC16)
angiopoietin-2 (Ang-2)
soluble intercellular adhesion molecule 1 (sICAM-1)
plasminogen activator inhibitor-1 (PAI-1)
soluble urokinase plasminogen activator receptor (sUPAR)
and high-mobility group box-1 (HMGB1) were tested within 24 h after admission. Logistic regression analysis was used to recognize the risk factors for accelerating the progress of the patients at high risk to ARDS and the factors influencing the prognosis of ARDS. Receiver operating characteristic (ROC) curve was used to compare the predictive effects of single factor or combination of multiple factors in early warning and outcome of ARDS for the sensitivity
specificity and Youden index.
Results
2
A total of 59 ARDS patients and 41 patients at high risk of ARDS were enrolled in this study. The independent risk factors for ARDS were HMGB1
sICAM-1
Ang-2
CC16 and PAI-1
and HMGB1 showed the best predictive effect with area under curve (AUC) of 0.908
followed by CC16 (0.861)
Ang-2 (0.858)
PAI-1 (0.801)
and sICAM-1 (0.773). In the single index analysis
the most sensitive indexes were HMGB1 and sICAM-1
both with the sensitivity of 79.7%
and the highest specific indexes were HMGB1
CC16 and Ang-2
all with the specificity of 87.8%. In the combined prediction
HMGB1 combined with Ang-2 had the highest specificity of 95.1% and the highest AUC of 0.92. The sensitivity of combining HMGB-1
Ang-2 and PAI-1 (89.9%) was the highest to predict. Multi-index combined prediction
to a certain extent
improved the sensitivity and specificity of diagnosis and prediction. sRAGE and Ang-2 were independent risk factors for death in ARDS prognosis. sRAGE (AUC=0.79) was better than Ang-2 (AUC=0.67) in predicting the death of ARDS patients. While the combination of the 2 indicators improved the specificity of the prediction.
Conclusion
2
HMGB1
sICAM-1
Ang-2
CC16 and PAI-1 are independent risk factors for patients at high risk of developing into ARDS. HMGB1 combined with Ang-2 shows better specificity
and combined with Ang-2 and PAI-1 together has better sensitivity in the prediction. For ARDS patients
increased sRAGE and Ang-2 indicate a poor prognosis in ARDS patients
and combination of these 2 indexes can improve the specificity of prediction.
关键词
Keywords
references
BROWER R G, LANKEN P N, MACINTYRE N, et al . Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome[J ] . N Engl J Med, 2004, 351(4): 327-336. DOI:10.1056/NEJMoa032193.
WARE L B, MATTHAY M A. The acute respiratory distress syndrome[J]. N Engl J Med, 2000, 342(18): 1334-1349. DOI:10.1056/NEJM200005043421806.
RUBENFELD G D, CALDWELL E, PEABODY E, et al . Incidence and outcomes of acute lung injury[J ] . N Engl J Med, 2005, 353(16): 1685-1693. DOI:10.1056/NEJMoa050333.
BRIGHAM K L. Lower tidal volume ventilation and plasma cytokine markers of inflammation in patients with acute lung injury[J]. Curr Infect Dis Rep, 2005, 7(5): 327-328. DOI:10.1007/s11908-005-0004-2.
WARE L B, CONNER E R, MATTHAY M A. von Willebrand factor antigen is an independent marker of poor outcome in patients with early acute lung injury[J]. Crit Care Med, 2001, 29(12): 2325-2331. DOI:10.1097/00003246-200112000-00016.
GALLAGHER D C, PARIKH S M, BALONOV K, et al . Circulating angiopoietin 2 correlates with mortality in a surgical population with acute lung injury/adult respiratory distress syndrome[J ] . Shock, 2008, 29(6): 656-661. DOI:10.1097/shk.0b013e31815dd92f.
THICKETT D R, ARMSTRONG L, CHRISTIE S J, et al . Vascular endothelial growth factor may contribute to increased vascular permeability in acute respiratory distress syndrome[J ] . Am J Respir Crit Care Med, 2001, 164(9): 1601-1605. DOI:10.1164/ajrccm.164.9.2011071.
GU W, XU Z, QI F, et al . Plasma levels of soluble receptor for advanced glycation end products in patients with acute respiratory distress syndrome[J ] . Int J Clin Exp Med, 2014, 7(12): 5558-5562.
KROPSKI J A, FREMONT R D, CALFEE C S, et al . Clara cell protein (CC16), a marker of lung epithelial injury, is decreased in plasma and pulmonary edema fluid from patients with acute lung injury[J ] . Chest, 2009, 135(6): 1440-1447. DOI:10.1378/chest.08-2465.
WARE L B, MATTHAY M A, PARSONS P E, et al . Pathogenetic and prognostic significance of altered coagulation and fibrinolysis in acute lung injury/acute respiratory distress syndrome[J ] . Crit Care Med, 2007, 35(8): 1821-1828. DOI: 10.1097/01.CCM.0000221922.08878.49.
AGRAWAL A, ZHUO H, BRADY S, et al . Pathogenetic and predictive value of biomarkers in patients with ALI and lower severity of illness: results from two clinical trials[J ] . Am J Physiol Lung Cell Mol Physiol, 2012, 303(8): L634-L639. DOI: 10.1152/ajplung.00195.2012.
RAYMONDOS K, MARTIN M U, SCHMUDLACH T, et al . Early alveolar and systemic mediator release in patients at different risks for ARDS after multiple trauma[J ] . Injury, 2012, 43(2): 189-195. DOI: 10.1016/j.injury.2011.05.034.
NAKAMURA T, SATO E, FUJIWARA N, et al . Increased levels of soluble receptor for advanced glycation end products (sRAGE) and high mobility group box 1 (HMGB1) are associated with death in patients with acute respiratory distress syndrome[J ] . Clin Biochem, 2011, 44(8/9): 601-604. DOI: 10.1016/j.clinbiochem.2010.12.014.
CALFEE C S, WARE L B, EISNER M D, et al . Plasma receptor for advanced glycation end products and clinical outcomes in acute lung injury[J ] . Thorax, 2008, 63(12): 1083-1089. DOI: 10.1136/thx.2008.095588.
WARE L B, KOYAMA T, ZHAO Z, et al . Biomarkers of lung epithelial injury and inflammation distinguish severe sepsis patients with acute respiratory distress syndrome[J ] . Critical Care, 2013, 17(5): R253. DOI: 10.1186/cc13080.
MANDELL L A, WUNDERINK R G, ANZUETO A, et al . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J ] . Clin Infect Dis, 2007, 44(Suppl 2): S27-S72. DOI: 10.1086/511159.
ARDS Definition Task Force, RANIERI V M, RUBENFELD G D, et al . Acute respiratory distress syndrome: the Berlin Definition[J ] . JAMA, 2012, 307(23): 2526-2533. DOI: 10.1001/jama.2012.5669.
FINK M P. Bench-to-bedside review: High-mobility group box 1 and critical illness[J]. Crit Care, 2007, 11(5): 229. DOI:10.1186/cc6088.
GRIFFITHS M J, MCAULEY D F. RAGE: a biomarker for acute lung injury[J]. Thorax, 2008, 63(12): 1034-1036. DOI: 10.1136/thx.2008.101493.
AGRAWAL A, MATTHAY M A, KANGELARIS K N, et al . Plasma angiopoietin-2 predicts the onset of acute lung injury in critically ill patients[J ] . Am J Respir Crit Care Med, 2013, 187(7): 736-742. DOI: 10.1164/rccm.201208-1460OC.
BRODSKA H, MALICKOVA K, VALENTA J, et al . Soluble receptor for advanced glycation end products predicts 28-day mortality in critically ill patients with sepsis[J ] . Scand J Clin Lab Invest, 2013, 73(8): 650-660. DOI: 10.3109/00365513.2013.849357.
ZHONG M, ZHANG L, WANG F, et al . The levels of angiopoietin-2 in patients with acute respiratory distress syndrome and its value on prognosis[J ] . Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2014, 26(11): 804-809. DOI: 10.3760/cma.j.issn.2095-4352.2014.11.008.
0
浏览量
0
下载量
0
CSCD
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies
