血浆可溶性晚期糖基化终末产物受体对急性呼吸窘迫综合征的诊断价值及预后意义

The diagnostic value and prognostic significance of plasma soluble receptor for advanced glycation endproducts in patients with ARDS

目的 探讨血浆可溶性晚期糖基化终末产物受体对急性呼吸窘迫综合征诊断的价值及预后意义.方法 本研究为前瞻性病例对照研究,将201 1年2月至2012年9月东南大学附属第二医院重症监护病房（ICU）收治的43例符合2012年急性呼吸窘迫综合征柏林定义及诊断标准患者,根据急性呼吸窘迫综合征柏林定义的患者氧合状态分为轻、中、重度三组,同时收集无肺损伤的住院患者20例作为对照组,根据28 d转归将急性呼吸窘迫综合征组分为生存组和死亡组两个亚组.入院24h内测定血常规、血气分析、血生化、C反应蛋白（CRP）,记录最高体温（T）,进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭估计（SOFA）评分；采用酶联免疫吸附法（ELISA）检测可溶性晚期糖基化终末产物受体水平.采用SPSS 17.0统计分析软件进行数据处理.计量资料采用方差或Mann-Whitney U检验,计数资料比较采用x2检验；绘制受试者工作特征曲线（ROC）.结果 急性呼吸窘迫综合征组患者血浆可溶性晚期糖基化终末产物受体浓度均显著高于无肺损伤组[377 （286.3 ～ 548.0）pg/ml]（P均＜0.05）,中、重度急性呼吸窘迫综合征组[分别为3188（1984～ 3042）,3273 （3170～3265） pg/ml]患者的可溶性晚期糖基化终末产物受体水平高于轻度急性呼吸窘迫综合征组[1707（1649～ 1870） pg/ml] （P ＜0.05）；死亡组可溶性晚期糖基化终末产物受体浓度[2996（2768～3319）pg/ml]明显高于生存组[2147（1965 ～ 2449） pg/ml],有统计学意义；可溶性晚期糖基化终末产物受体诊断急性呼吸窘迫综合征的ROC曲线下面积为0.912,以842 pg/ml为截断值,灵敏度为92.7％,特异度为87.8％,优于CRP.结论 血浆可溶性晚期糖基化终末产物受体水平对急性呼吸窘迫综合征诊断有一定价值,高浓度的可溶性晚期糖基化终末产物受体与急性呼吸窘迫综合征不良预后相关.

Objective To evaluate the diagnostic value and prognostic significance of plasma soluble receptor for advanced glycation end-products in patients with ARDS.Methods The present study is a prospective randomly control clinical research.From February 2011 to September 2012,a total of 43 patients admitted to intensive care unit （ICU） of the Affiliated Second Hospital of Southeast University developed ARDS diagnosed by Acute Respiratory Distress Syndrome：The Berlin Definition in 2012 were enrolled.According to the criteria of The Berlin Definition of Acute Respiratory Distress Syndrome,patients were divided into mild group（n =16）,moderate group （n =18）and severe group（n =9） ;meanwhile,20 no lung injury in-patients were collected as control group.Patients with ARDS were further divided into two subgroups：survival subgroup and non-survival subgroup according to 28 days outcomes.Blood routine examination,blood gase analysis,blood biochemistry examination,C reaction protein（CRP）,APACHE Ⅱ scores and Sequential OrganFailure Assessment score （SOFA）were determined with 24 hours after admission.The peak body temperature of all patients were registered in hospitalization period.Plasma level of sRAGE was measured by enzyme linked immunosorbant assay（ELISA）.Quantitative data were analyzed by F-teat or MannWhitney U test.Enumeration data were analyzed by x2 test.Results The plasma level of sRAGE in patients of ARDS was significantly higher than that in control group [377 （286.3-548.0） pg/ml] （P 〈 0.05）.Additionally,the sRAGE concentration of moderate [3188 （1984-3042） pg/ml] and severe [3273 （3170-3265） pg/ml] ARDS group was higher than mild group [1707 （1649-1870） pg/ml].Compared with that of survival group [2147 （1965-2449） pg/ml],the plasma level of sRAGE in non-survival group [2996 （2768-3319）pg/ml] was elevated significantly.The area under the ROC curve was 0.912 for a cut-off value of 842 pg/ml,with a sensitivity of 92.7% and a specificity of 87.8%,superior to CRP.Conclusion sRAGE levels were elevated during ARDS,maybe is a useful early biomarker in diagnosis of ARDS.The increase in the plasma concentration of sRAGE was correlated with poor outcome of patients with ARDS.