多器官功能障碍评分系统:3个评分标准预测多器官功能障碍综合征结局关联性和准确性的比较与评估

Multiple organ dysfunction scoring system: comparison and evaluation of correlation and accuracy of the three scoring systems in predicting the outcome of multiple organ dysfunction syndrome on highland

目的研究高原急性呼吸窘迫综合征(HARDS)/多器官功能障碍综合征(MODS)各项诊断指标参数的变化特点,比较3个MODS评分标准预测结局的准确性。方法统一按通用的MODS诊断标准将540例ARDS/MODS患者按海拔高度分为平原对照组(CG,<430m,n=113)、中度高原1组(H1G,1517m,n=314)、中度高原2组(H2G,2261～2400m,n=78)和高原组(HG,2808～3400m,n=35)。4组分别用平原地区ARDS/MODS评分诊断标准(庐山会议评分标准和Marshall评分标准)以及兰州修订的HARDS/MODS评分标准(兰州标准),建立3个标准的数据统计模型,分别绘制受试者运行特征性曲线(ROC曲线),计算约登指数(Yoden)和最佳界值,验证3个标准在不同海拔高度预测ARDS/MODS结局的准确性;用向前逐步回归模式对影响MODS结局的多因素进行分析。结果用庐山、Marshall和兰州标准检验平原和高原不同海拔高度MODS总分的ROC曲线下面积,预测结局的敏感度、特异度及其最佳界值,结果显示,随海拔梯度上升,兰州标准明显优于庐山和Marshall标准,多元Logistic回归分析也以兰州标准的影响因素最大。结论1通用的ARDS/MODS诊断标准中某些参数界值可能不适合中度高原以上地区,建立HARDS/MODS标准是必要的,兰州标准随海拔梯度升高有进一步提高预测准确性的趋势。2海拔高度大于1500m以上地区?

Objective To study the characteristics of the diagnostic parameters of acute respiratory distress syndrome/multiple organ dysfunction syndrome on plateau (HARDS/MODS) and compare the accuracyof the three MODS scoring criteria in predicting the outcome of syndrome. Methods Five hundred and forty cases fulfilling the criteria of MODS were divided into four groups according to the altitude of their inhabitation area: control group (on plain, CG, n=113, altitude: <430 m), moderate high altitude group 1 (H1G, n=314, altitude: 1 517 m), moderate high altitude group 2 (H2G, n=78, altitude: 2 261 m to 2 400 m ) and high altitude group (HG, n=35, altitude: 2 808 m to 3 400 m). According to the diagnostic criteria of Lushan conference and Marshall (1995) commonly used on plain, and Lanzhou criteria drafted by the authors , three data analyzing models were set up to draw the receiver operating characteristic (ROC) curves,the Yordon Index and the optimum cutoff points of the parameters were calculated and the accuracy of the three respective diagnostic criteria was evaluated in predicting the outcome of ARDS/MODS. Multiple factors affecting the outcome of MODS were analyzed using the method of stepwise forward regress model. Results Following the increase in altitude, Lanzhou criteria was clearly superior to the other two criteria in the area of ROC , the sensitivity, the specificity, and also for the optimum cutoff points of MODS. Multivariableregression analysis showed that the impacting factor of Lanzhou criteria was the highest (P<0.05) . Conclusion ①Some parameters of the current diagnostic criteria of ARDS/MODS are not suitablein moderately high or high altitude areas. It is necessary to set up the diagnostic criteria of HARDS/MODS . ②Some clinical characteristics might change in areas 1500 m altitude or higher. The pathophysiologicalmechanism might be attributable to peculiar biologic reactions due to hypoxia stress reaction , and it is worth further study.