摘要
目的探讨血清C1q在脓毒症合并不同严重程度急性呼吸窘迫综合征(ARDS)患者中的表达和临床价值。方法收集2022年1月—2023年7月武汉大学人民医院重症医学科、呼吸重症科及传染科的脓毒症合并ARDS患者109例的临床资料,检测患者入院24 h内实验室指标。根据入院28 d内的生存情况将患者分为存活组63例和死亡组46例,根据ARDS严重程度分为轻度组32例、中度组38例、重度组39例。比较死亡组和存活组的临床资料及实验室检测指标,不同严重程度患者血清C1q水平,并利用受试者工作特征(ROC)曲线分析血清C1q水平对脓毒症合并ARDS患者预后预测的价值。结果死亡组年龄、SOFA评分、降钙素原(PCT)、N末端脑钠肽前体(NT-proBNP)、尿素(UREA)、血尿酸(UA)及肌酐(SCr)均明显高于存活组[Z(t)/P=2.280/0.025、4.241/<0.001、2.031/0.042、2.945/0.003、2.896/0.004、2.068/0.039、2.218/0.027],前白蛋白(PA)、总蛋白(TP)、白蛋白(Alb)、PaO 2及氧合指数(OI)均明显低于存活组[Z(t)/P=2.279/0.023、2.341/0.019、2.700/0.007、4.048/<0.001、6.182/<0.001],且死亡组较存活组脓毒性休克占比大,差异均有统计学意义(χ^(2)/P=4.718/0.030);血清C1q水平死亡组低于生存组(t/P=4.065/<0.001),重度组<中度组<轻度组(F/P=43.494/<0.001);相关性分析血清C1q与OI呈正相关,与SOFA评分呈负相关(r/P=0.658/<0.001、-0.393/<0.001);多因素Logistic回归分析Alb、C1q及OI水平低,年龄大是脓毒症并发ARDS患者死亡的独立危险因素[OR(95%CI)=1.112(1.018~1.213)、1.029(1.003~1.055)、1.020(1.004~1.036)、1.004(0.997~1.010)]。血清C1q预测脓毒症合并ARDS患者预后的AUC为0.776,95%CI为0.689~0.862,Cut-off值为152.25 mg/L,敏感度、特异度和约登指数分别为为0.804、0.619和0.423。结论血清C1q水平与脓毒症并发ARDS患者病情严重程度具有密切关系,血清C1q水平低是脓毒症并发ARDS患者死亡的独立危险因素,且其检测对脓毒症并发ARDS诊�
Objective To investigate the expression and clinical value of serum C1q in patients with sepsis complicated with acute respiratory distress syndrome(ARDS)of different severity levels.Methods Collect clinical data of 109 patients with sepsis complicated with ARDS from the Intensive Care Department,Respiratory Intensive Care Department,and Infectious Diseases Department of Wuhan University People's Hospital from January 2022 to July 2023,and test laboratory indicators within 24 hours of admission.According to the survival status within 28 days of admission,the patients were divided into a survival group of 63 cases and a death group of 46 cases.According to the severity of ARDS,they were divided into a mild group of 32 cases,a moderate group of 38 cases,and a severe group of 39 cases.Compare clinical data and laboratory testing indicators between the death group and the survival group,analyze serum C1q levels in patients with different severity levels,and use receiver operating characteristic(ROC)curves to analyze the value of serum C1q levels in predicting the prognosis of sepsis patients with ARDS.Results The age,SOFA score,procalcitonin(PCT),N-terminal proBNP,urea,blood uric acid,and creatinine of the death group were significantly higher than those of the survival group[Z(t)/P=2.280/0.025,4.241/<0.001,2.031/0.042,2.945/0.003,2.896/0.004,2.068/0.039,2.218/0.027].Pre albumin(PA),total protein(TP),albumin(Alb),PaO 2,and oxygenation index(OI)were significantly lower than those of the survival group[Z(t)/P=2.279/0.023,2.341/0.019,2.700/0.007,4.048/<0.001,6.182/<0.001],and there was a statistically significant difference in the proportion of septic shock between the death group and the survival group(χ^(2)/P=4.718/0.030).The serum C1q levels in the death group were lower than those in the survival group(t/P=4.065/<0.001),and the severe group<moderate group<mild group(F/P=43.494/<0.001).Correlation analysis showed a positive correlation between serum C1q and OI,and a negative correlation with SOFA score(r/P=0.658/<0.
作者
张烨
蔡馨
王历
汤冬玲
张平安
Zhang Ye;Cai Xin;Wang Li;Tang Dongling;Zhang Ping’an(Department of Clinical Laboratory,Renmin Hospital of Wuhan University,Hubei Province,Wuhan 430060,China)
出处
《疑难病杂志》
CAS
2024年第2期138-142,共5页
Chinese Journal of Difficult and Complicated Cases
基金
国家自然科学基金资助项目(81773444)。
