摘要
目的探讨内皮糖萼降解产物在评估急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺水肿严重程度的应用。方法采用前瞻性研究,选取2018年7月1日至2019年12月31日在无锡市人民医院诊断为ARDS的患者。患者入科2 h内行脉搏指示连续心排血量监测记录血管外肺水指数(extravascular lung water index,EVLWI),同时用酶联免疫吸附试验检测糖萼降解产物[血浆多配体聚糖-1(syndecan-1,SDC-1)、硫酸乙酰肝素(heparan sulphate,HS)、透明质酸(hyaluronic acid,HA)]指标及炎症因子[血肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-6、IL-10]浓度。采用Pearson相关法分析ARDS患者糖萼降解产物与EVLWI、炎症因子的相关性。以EVLWI 10 mL/kg为界值,将患者分为轻度肺水肿组和重度肺水肿组,比较两组患者糖萼降解产物以及炎症因子指标的差别。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),分析糖萼降解产物对于判断肺水肿严重程度的价值。结果入选ARDS患者共85例,Pearson相关性分析显示,患者SDC-1、HS、HA均与IL-6、TNF-α、EVLWI呈正相关(均P<0.05),均与IL-10无相关性(均P>0.05)。在轻度肺水肿组(39例)与重度肺水肿组(46例)进行对比显示,IL-6[(33.63±3.43)ng/L vs.(39.99±4.64)ng/L]、TNF-α[(43.38±6.05)ng/L vs.(50.79±7.35)ng/L]、SDC1[(494.13±47.23)ng/L vs.(563.50±56.36)ng/L]、HS[(114.02±18.39)ng/mL vs.(138.93±17.02)ng/mL]、HA[(441.44±62.52)ng/mL vs.(546.23±85.24)ng/mL]在两组间差异有统计学意义(均P<0.05),IL-10[(24.37±10.11)ng/L vs.(28.75±11.98)ng/L]两组间差异无统计学意义(P>0.05)。ROC曲线分析显示,将SDC-1、HA、HS三者指标联合预测优于单项指标,其ROC曲线下面积为0.928(95%CI:0.872~1.000),敏感度和特异度分别为87.5%、86.7%。结论ARDS患者糖萼降解产物SDC-1、HS、HA均与血管外肺水指数存在良好的相关性,三项糖萼降解产物指标的应用�
Objective To investigate the application of endothelial glycocalyx degradation products in assessing the severity of pulmonary edema in patients with acute respiratory distress syndrome(ARDS).Methods A prospective study was conducted to select patients diagnosed with ARDS at Wuxi People's Hospital from July 1,2018 to December 31,2019.The extravascular lung water index(EVLWI)was recorded within 2 h after admission by continuous cardiac output with pulse indicator.The indexes of glycocalyx degradation products syndecan-1(SDC-1),heparan sulfate(HS),hyaluronic acid(HA)and the concentrations of inflammatory factors[blood tumor necrosis factorα(TNF-α),interleukin(IL)-6 and IL-10]were measured by enzyme-linked immunosorbent assay.Pearson correlation method was adopted to analyze the correlation of glycocalyx degradation products with EVLWI and inflammatory factors in ARDS patients.The patients were divided into the mild pulmonary edema group and severe pulmonary edema group according to EVLWI at the cut-off value of 10 mL/kg,and the differences of glycocalyx degradation products and inflammatory factors between the two groups were compared.Receiver operating characteristic(ROC)curve of the subjects were plotted to analyze the value of glycocalyx degradation products in determining the severity of pulmonary edema.Results A total of 85 ARDS patients were enrolled.Pearson correlation analysis showed that SDC-1,HS,and HA were all positively correlated with IL-6,TNF-α,EVLWI(all P<0.05),but did not correlate with IL-10(all P>0.05).Comparison of indicators between the mild pulmonary edema group(39 cases)and the severe pulmonary edema group(46 cases)showed that:IL-6[(33.63±3.43)ng/L vs.(39.99±4.64)ng/L],TNF-α[(43.38±6.05)ng/L vs.(50.79±7.35)ng/L],SDC-1[(494.13±47.23)ng/L vs.(563.50±56.36)ng/L],HS[(114.02±18.39)ng/mL vs.(138.93±17.02)ng/mL],and HA[(441.44±62.52)ng/mL vs.(546.23±85.24)ng/mL]were statistically different between the two groups(all P<0.05).Whereas,IL-10[(24.37±10.11)ng/L vs.(28.75±11.98)ng/L]was not
作者
吴丁烨
高飞
梁锋鸣
杨挺
高嵩
Wu Dingye;Gao Fei;Liang Fengming;Yang Ting;Gao Song(Department of Critical Care Medicine,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2023年第1期95-100,共6页
Chinese Journal of Emergency Medicine
基金
江苏省临床重点专科建设项目(2019-10)。
