血清1-磷酸鞘氨醇、生长分化因子-15、尿酸水平对急性呼吸窘迫综合征患者临床预后影响

Effect of serum sphingosine 1-phosphate,growth differentiation factor-15 and uric acid on the clinical prognosis of patients with acute respiratory distress syndrome

目的探讨血清1-磷酸鞘氨醇(S1P)、生长分化因子-15(GDF-15)、尿酸水平对急性呼吸窘迫综合征(ARDS)患者临床预后的影响,分析其用于预测患者预后的价值。方法选取自2018年1月至2020年1月收治的100例ARDS患者为观察组,根据氧合指数将患者分为轻度组(200 mmHg<氧合指数≤300 mmHg,n=40)、中度组(100 mmHg<氧合指数≤200 mmHg,n=29)与重度组(氧合指数≤100 mmHg,n=31);根据患者治疗后28 d存活情况,分为病死组(n=34)与存活组(n=66)。同时,选取同期体检的100例健康者为健康组。检测并比较各组血清S1P、GDF-15、尿酸水平。记录观察组患者入院时序贯器官衰竭评估(SOFA)评分、急性生理与慢性健康评分Ⅱ(APACHEⅡ),比较病死组与存活组SOFA评分、APACHEⅡ评分。采用多因素Logistic回归分析对S1P、GDF-15、尿酸与ARDS患者28 d死亡的相关性进行分析;采用受试者工作特征曲线分析S1P、GDF-15、尿酸用于评估ARDS患者28 d死亡风险的价值。结果观察组血清GDF-15、尿酸水平高于健康组,血清S1P水平低于健康组,差异有统计学意义(P<0.05)。重度组、中度组血清S1P水平低于轻度组,且重度组低于中度组;重度组、中度组血清GDF-15、尿酸水平高于轻度组,且重度组高于中度组,差异均有统计学意义(P<0.05)。病死组患者血清GDF-15、尿酸、APACHEⅡ评分、SOFA评分均高于存活组,血清S1P水平低于存活组,差异均有统计学意义(P<0.05)。多因素Logistics回归分析结果显示,APACHEⅡ评分、SOFA评分以及血清S1P、GDF-15、尿酸是影响ARDS患者28 d死亡的独立危险因素(P<0.05)。血清S1P、GDF-15、尿酸预测ARDS患者预后的受试者工作特征曲线下面积分别为0.843(95%可信区间0.726~0.961,P<0.05)、0.928(95%可信区间0.856~0.985,P<0.05)、0.789(95%可信区间0.661~0.917,P<0.05)。结论ARDS患者血清S1P、GDF-15、尿酸水平与其病情严重程度和预后有关,对ARDS患者28 d死亡风险具有较高预测价值。

Objective To investigate the relationship between serum sphingosine 1-phosphate(S1P),growth differentiation factor-15(GDF-15),uric acid levels and the clinical prognosis of patients with acute respiratory distress syndrome(ARDS).Methods A total of 100 patients with ARDS who were admitted from January 2018 to January 2020 were selected as the observation group.According to oxygenation index,the patients were divided into the mild group(200 mmHg<oxygenation index≤300 mmHg,n=40),moderate group(100 mmHg<oxygenation index≤200 mmHg,n=29)and severe group(oxygenation index≤100 mmHg,n=31).According to the survival situation of the patients 28 days after treatment,the patients were divided into the death group(n=34)and the survival group(n=66).At the same time,100 healthy people who had physical examination during the same period were selected as the healthy group.Serum S1P,GDF-15 and uric acid levels were detected and compared in each group.The sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)of the observation group of patients admitted to hospital temporal were recorded,SOFA score and APACHEⅡscore were compared between the death group and the survival group.Multivariate Logistic regression analysis was used to analyze the correlation between S1P,GDF-15,uric acid and mortality of ARDS patients at 28 days.Receivers operating characteristic(ROC)curve was used to analyze the value of S1P,GDF-15 and uric acid in evaluating the 28-day mortality risk of ARDS patients.Results The serum levels of GDF-15 and uric acid in the observation group were higher than those in the healthy group,and the serum levels of S1P in the observation group were lower than those in the healthy group,with statistically significant differences(P<0.05).Serum S1P levels in severe group and moderate group were lower than those in mild group,and S1P levels in severe group were lower than those in moderate group.Serum levels of GDF-15 and uric acid in severe group and moderate group were higher than those in mild group,and levels of GDF-15 in severe group were higher than those in moderate group(P<0.05).The serum GDF-15,uric acid,APACHEⅡscore and SOFA score of the death group were higher than those of the survival group,and the serum S1P level was lower than that of the survival group(P<0.05).Multi-factor Logistics regression analysis results showed that the APACHEⅡgrade,SOFA scores,S1P,GDF-15 and serum uric acid were independent risk factors for ARDS patients died within 28 days(P<0.05).The area under the ROC curve of serum S1P,GDF-15 and uric acid for predicting the prognosis of ARDS patients was 0.843(95%CI:0.726-0.961,P<0.05),0.928(95%CI:0.856-0.985,P<0.05)and 0.789(95%CI:0.661-0.917,P<0.05),respectively.Conclusion Serum levels of S1P,GDF-15 and uric acid in ARDS patients are related to the severity of the disease and prognosis,and have a high predictive value for the 28-day mortality risk of ARDS patients.