血管生成素-2与严重脓毒症肺毛细血管渗漏的相关性研究

Correlation between Angiopoietin-2 and pulmonary capillary leak in severe septic patients

目的：探讨血清血管生成素-2（Ang-2）水平在严重脓毒症患者发病不同时间预测渗漏性肺水肿的价值.方法：采用前瞻性设计,将42例发病后6h内收入院的严重脓毒症患者,按照血管外肺水指数（EVLWI）值,分为渗漏组及非渗漏组,另选同期门诊健康体检者20例为对照组.所有患者入院后第0（入院时）、1、3、5天清晨抽取外周静脉血离心取血清,酶联免疫吸附法检测Ang-2浓度,记录每天的EVLWI值.采用t检验比较两组间血清Ang-2水平的差异,接收者工作特征曲线（ROC曲线）下面积法检验Ang-2的预测效力,Spearman秩相关分析Ang-2与EVLWI的相关性.结果：与对照组相比,严重脓毒症患者发病后各时间点血清Ang-2均明显升高,差异有统计学意义（P＜0.01）;渗漏组与非渗漏组相比,第0、1天血清Ang-2水平显著升高,差异有统计学意义（P＜0.05）,第3、5天血清Ang-2水平两组间比较,差异无统计学意义（P＞0.05）;第0天血清Ang-2预测渗漏性肺水肿的曲线下面积为0.748（P＜0.01,95％CI：0.548～0.912）;相关性分析显示,第0天Ang-2与EVLWI有显著相关性,r=0.732（P＜0.01）.结论：发病早期（12h内）明显升高的Ang-2对判断严重脓毒症渗漏性肺水肿的形成有一定的临床价值.

Objective：To investigate the clinical effect of serum angiopoietin-2 （Ang-2） levels in predicting permeable pulmonary edema in severe septic patients.Methods：A total of 42 patients who were suffering from severe sepsis were enrolled in this study.According to extravascular lung water index（EVLWI） on admission,all patients were divided into leaky group（n=15） and non-leaky group（n=27）,while 20 healthy volunteers from out-patient department were studied as control group.Peripheral blood samples were collected on admission and the morning of 1 st,3rd and 5th days.Ang-2 levels were measured using ELISA.EVLWI was recorded for five consecutive days.Ang-2 levels between the two groups were compared using Student＇s t-test.The validity of predicting severe septic patients＇ pulmonary capillary leak with Ang-2 levels was verified by receiver operating characteristic curves （ROC curves）.Spearman rank correlation was used to analyze the correlation between Ang-2 levels and EVLWI at different times.Results：Ang-2 levels in severe septic group was significantly higher than that in control group（P〈0.01）; Ang-2 levels in leaky group was significantly higher than that in non-leaky group on admission and the 1st day （P〈0.05） but no significant difference between the two groups were found on the 3rd and 5th days （P〉0.05）; ROC curves area of Ang-2 levels on admission for predicting the permeable pulmonary edema was 0.748 （P〈0.01,95%CI：0.548-0.912）;Ang-2 levels was positively correlated to EVLWI on admission,r =0.732（P〈0.01）.Conclusion：Ang-2 elevated significantly in the early course has certain clinical effect in predicting permeable pulmonary edema in severe septic patients.