序贯器官衰竭评分联合Clara细胞蛋白和血管生成素-2对脓毒症所致ARDS的预测价值

doi:10.11958/20242304

摘要/Abstract

摘要：

目的探究序贯器官衰竭评分（SOFA）联合血清Clara细胞蛋白16（CC16）、血管生成素-2（Ang-2）对脓毒症所致急性呼吸窘迫综合征（ARDS）患者预后的预测价值。方法以入院后72 h内是否并发ARDS，将173例脓毒症患者分为并发组76例和未并发组97例；根据并发组患者30 d内死亡情况分为死亡组35例和生存组41例。酶联免疫吸附试验（ELISA）检测患者血清CC16、Ang-2、C反应蛋白（CRP）、白细胞介素（IL）-6；全自动生化分析仪及血细胞计数仪检测甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）及白细胞计数（WBC）水平。入院时对患者进行SOFA评分；比较2组患者生化指标、SOFA评分、CC16及Ang-2水平，分析患者预后不良情况；影响因素分析用二分类Logistic回归；受试者工作特征（ROC）曲线分析相关因素对脓毒症并发ARDS患者预后不良的预测效能。结果并发组血清CRP、IL-6、CC16、Ang-2水平及SOFA评分高于未并发组（P<0.05）；死亡组SOFA评分、机械通气时间、CRP、CC16、Ang-2水平高于生存组（P<0.05）。SOFA评分升高和高水平的CC16、Ang-2是并发组发生预后不良的独立危险因素（P<0.05）；SOFA评分、血清CC16、Ang-2水平及三者联合预测脓毒症并发ARDS患者预后不良的ROC曲线下面积（AUC）分别为0.806（0.700~0.888）、0.801（0.693~0.884）、0.845（0.743~0.918）、0.945（0.867~0.984）。结论 SOFA评分联合CC16、Ang-2水平变化可用于综合评估脓毒症并发ARDS患者预后情况。

关键词: 脓毒症, 呼吸窘迫综合征, 血管生成素2, 子宫珠蛋白, 预后, ROC曲线

Abstract:

Objective To explore the predictive value of sequential organ failure score (SOFA) combined with serum Clara cell protein 16 (CC16) and angipoietin-2 (Ang-2) in the prognosis of patients with acute respiratory distress syndrome (ARDS) caused by sepsis. Methods A total of 173 sepsis patients were divided into the concurrent group (n=76) and the non-concurrent group (n=97), based on whether ARDS occurred within 72 h after admission. According to the death situation within 30 days, patients in the concurrent group were divided into the death group (n=35) and the survival group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect serum CC16, Ang-2, C-reactive protein (CRP) and interleukin (IL)-6. The levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and white blood cell count (WBC) were detected by automatic biochemical analyzer and hemocytometer. SOFA scores were performed on patients at admission. The biochemical indexes, SOFA score, CC16 and Ang-2 levels were compared between the two groups, and the poor prognosis of the patients was analyzed. Binary Logistic regression was used for influencing factor analysis. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of related factors in the poor prognosis of patients with sepsis complicated by ARDS. Results The serum levels of CRP, IL-6, CC16, Ang-2 and SOFA scores were higher in the concurrent group than those in the non-concurrent group (P<0.05). The SOFA score, mechanical ventilation time, CRP, CC16 and Ang-2 were higher in the death group than those in the survival group (P<0.05). High SOFA score, CC16 and Ang-2 were independent risk factors for poor prognosis in the concurrent group (P<0.05). The area under the curve (AUC) of SOFA score, serum CC16 and Ang-2 levels in predicting poor prognosis in patients with sepsis complicated with ARDS were 0.806 (0.700-0.888), 0.801 (0.693-0.884), 0.845 (0.743-0.918) and 0.945 (0.867-0.984), respectively. Conclusion SOFA score combined with changes in CC16 and Ang-2 expression levels can be used to comprehensively evaluate prognosis of patients with sepsis complicated with ARDS.

Key words: sepsis, respiratory distress syndrome, angiopoietin-2, uteroglobin, prognosis, ROC curve

中图分类号:

R563，R441.8

图/表 6

参考文献 17

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组别		n	CRP/（mg/L）		IL-6/（ng/L）		TG/（mmol/L）
未并发组		97	20.83±4.85		313.32±68.41		1.62±0.42
并发组		76	24.71±5.29		351.76±71.35		1.63±0.45
t			5.018^＊		3.599^＊		0.151
组别	TC/ （mmol/L）			LDL-C/ （mmol/L）		HDL-C/ （mmol/L）		WBC/ （×10⁹/L）
未并发组	4.47±0.59			2.85±0.72		1.39±0.21		10.27±2.61
并发组	4.51±0.73			2.86±0.77		1.35±0.26		10.39±2.71
t	0.399			0.088		1.119		0.295

组别		n	CRP/（mg/L）		IL-6/（ng/L）		TG/（mmol/L）
未并发组		97	20.83±4.85		313.32±68.41		1.62±0.42
并发组		76	24.71±5.29		351.76±71.35		1.63±0.45
t			5.018^＊		3.599^＊		0.151
组别	TC/ （mmol/L）			LDL-C/ （mmol/L）		HDL-C/ （mmol/L）		WBC/ （×10⁹/L）
未并发组	4.47±0.59			2.85±0.72		1.39±0.21		10.27±2.61
并发组	4.51±0.73			2.86±0.77		1.35±0.26		10.39±2.71
t	0.399			0.088		1.119		0.295

组别	n	CC16/（μg/L）	Ang-2/（ng/L）	SOFA评分/分
未并发组	97	64.31±14.36	4.14±0.93	13.76±2.59
并发组	76	87.52±16.75	5.36±1.07	19.26±3.52
t		9.804^＊＊	8.013^＊＊	11.837^＊＊

组别	n	CC16/（μg/L）	Ang-2/（ng/L）	SOFA评分/分
未并发组	97	64.31±14.36	4.14±0.93	13.76±2.59
并发组	76	87.52±16.75	5.36±1.07	19.26±3.52
t		9.804^＊＊	8.013^＊＊	11.837^＊＊

组别	n		SOFA评分/分		机械通气时间/d		CRP/（mg/L）
生存组	41		16.63±2.51		3.85±0.92		21.29±4.61
死亡组	35		22.35±2.42		5.72±1.39		28.72±5.36
t			10.067^＊＊		7.006^＊＊		6.498^＊＊
组别		IL-6/（ng/L）		CC16/（μg/L）		Ang-2/（ng/L）
生存组		346.55±69.31		79.67±11.42		4.57±0.93
死亡组		357.86±74.27		96.71±12.75		6.28±1.15
t		0.686		6.145^＊＊		7.166^＊＊