摘要
目的探讨血清血管内皮钙黏蛋白（vascularendothelialcadherine，VE_cad）水平与脓毒症并发急性呼吸窘迫综合征（acuterespiratorydistresssyndrome，ARDS）患者疾病严重程度及预后的关系。方法2015年6月至2017年12月天津医科大学第二医院综合ICU收治的脓毒症并发ARDS患者48例，选取同期30名健康体检者作为健康对照组。48例ARDS患者中轻度17例，中度18例，重度13例。检测第1、3、7天血清VE-Cad、TNF-α和IL-6水平。比较各组血管外肺水指数（extravascularlungwaterindex，EVLwI）、肺血管通透性指数（pulmonaryvascularpermeabilityindex，PVPI），肺损伤评分（1unginjuryscore，LIS）、急性生理学与慢性健康状况（APACHEII）评分和序贯器官功能衰竭（SOFA）评分。两组间比较采用t检验或Z。检验，多组间比较采用单因素方差分析。结果入院第1天ARDS组患者血清VE-Cad为（5．67±0．29）μ／L，高于健康对照组的（O．28±0．03）μ／L，两组比较差异有统计学意义（t-101．2，P〈0．01）。轻、中、重度ARDS患者血清VE-Cad水平分别为（1．52±0．59）、（3．45士0．68）和（4．86±0．53）μ／L，组问比较差异有统计学意义（F-15．45，P〈0．01）。ARDS患者血清VE-Cad与EVLwI、PVPI、LIS、TNF-α和IL-6均正呈相关（r值分别为0．640、0．601、0．507、0．584和0．456，均P〈0．01）。17例死亡组患者的氧合指数（Pa02／Fi02）为（146．74±16．45）mmHg（1mmHg=0．133kPa），血清白蛋白为（23．18±3．24）g／L，均低于31例生存组患者的（245．42±12．13）mmHg和（29．16±3．45）g／L，比较差异均有统计学意义（￡值分别为23．72、5．865，均P〈0．01）；而EVLwI、PVPI、LIS、乳酸、机械通气时间、7d液体平衡量、APACHEⅡ评分和SOFA评分均高于生存组。生存组患者第1、3和7天血清VE-Cad水平分别为（3．36±0．47）、（1．95±0．42）和（0．96±0．28）μ／L，均�
Objective To investigate the prognostic significance of serum vascular endothelial cadherine （VE-Cad） in patients with acute respiratory distress syndrome （ARDS） induced by sepsis. Methods A prospective observational study was performed between June 2015 and Dec 2017, and 48 ARDS patients induced by sepsis from intensive care unit （ICU） were enrolled. And 30 healthy volunteers were enrolled as control. ARDS group was divided into mild group （n= 17）, moderate group （n= 18） and severe group （n = 13）. The dynamic levels of serum VECad, tumor necrosis factor a （TNF-α） and interleukin-6 （IL-6） were monitored at day 1, 3 and 7 of admission. Clinical data including extravascular lung water index （EVLWI）, pulmonary vascular permeability index （PVPI）, lung iniury score （LIS）, APACHE II and SOFA were also collected. The t-test or chi square test were used in the comparison between the two groups. One-way ANOVA was used for comparison among multiple groups. Results The serum VE-Cad level of septic group was higher than control group at day 1 of admission （[5.67± 0. 291 vs [0. 28± 0. 031 tzg/L, t=101. 2, P〈0. 01）. The serum VE-Cad levels in the mild group, moderate group and severe group were （1. 52±0. 59）, （3. 45-b0. 68）, and （4. 68±0. 53） ptg/L, respectively （F= 15.45, P〈0.01）. There were positive correlation between VECad levels and EVLWI, PVPI, LIS, TNF-α and IL-6 （r=0. 640, 0. 601, 0.507, 0. 584, and 0.456, respectively, all P〈0.01）. The PaO2/FiO2 and serum albumin level in death group （n= 17） were lower than survival group （n= 31） （[-146.74±16. 451 vs [-245.42±12. 131 mmHg [1 mmHg--0. 133 kPa】, t=23.72, P〈0.01; [23.18＋ 3.241 vs E29.16 ＋ 3. 452 g/L, t=5. 865, P〈0. 01, respectively）, and EVLWI , PVPI, LIS, serum lactate, mechanical ventilation time, 7 d fluid balance, APACHE 11 and SOFA in death group were all higher than survival group. The serum VE-Cad levels at day 1, 3 and 7 in death group were all higher than s
作者
李真玉
李伟
宗晓龙
胡慧卿
陈兵
Li Zhenyu;Li Wei;Zong Xiaolong;Hu Huiqing;Chen Bing(Intensive Care Unit,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)
出处
《中华传染病杂志》
CAS
CSCD
2018年第8期461-465,共5页
Chinese Journal of Infectious Diseases
基金
天津市卫生和计划生育委员会科技基金（2014KZ103）
