肺血管通透性指数对急性肺损伤患者的预后价值

Prognostic value of pulmonary vascular permeability index in patients with acute lung injury

目的探讨肺血管通透性指数(PVPI)对急性肺损伤(ALI)患者的预后判断价值。方法收集2010年10月至2013年10月入住重症医学科(ICU),需要机械通气的64例ALI患者,根据预后分为急性呼吸窘迫综合征(ARDS)组(30例)和非ARDS组(34例)。比较两组患者入组时的心指数、平均中心静脉压(CVPm)、全心舒张末容积指数(GEDVI)、PVPI、血管外肺水指数(EVLWI)、氧合指数和肺损伤评分(LIS)等指标。绘制ROC曲线,根据曲线下面积(AUC)评价PVPI对ARDS的预测价值,最佳诊断临界值评估其敏感性和特异性。结果非ARDS组入组时的PVPI、EVLWI和LIS均显著低于ARDS组(P均<0.05),而两组间心指数、CVPm、GEDVI和氧合指数等指标比较差异均无统计学意义(P均>0.05)。PVPI预测ALI患者发生ARDS的AUC为0.886;最佳诊断临界值为3.10时,敏感度为93.3%,特异度为82.4%。结论 PVPI能早期评估ALI的严重程度,可作为预测ALI患者是否会进展为ARDS的参考指标之一。

Objective To assess the prognostic value of pulmonary vascular permeability index （PVPI） in patients with acute lung injury （ALI）. Methods A total of 64 ALI patients admitted to the ICU and treated by invasive mechanical ventilation from October 2010 to October 2013 were enrolled. According to the prognosis, these patients were divided into the acute respiratory distress syndrome （ARDS） group （30 cases） and non-ARDS group （34 cases）. Cardiac index, mean central venous pressure （CVPm）, global end diastolic volume index （GEDVI）, PVPI, extravascular lung water index （EVLWI）, oxygen index and lung injury score （LIS） were recorded and compared between the two groups. The ROC curve was used to evaluate the prognostic value of PVPI for ARDS, and the sensitivity and specificity were assessed by the best diagnostic cut-off point. Results The PVPI, EVLWI and LIS in the non- ARDS group were much lower than those in the ARDS group （all P〈 0.05）. There were no significant differences in cardiac index, CVPm, GEDVI and oxygen index between the two groups （all P 〉 0.05）. The area under ROC curve for PVPI to predict ARDS in the ALI patients was 0.886, sensitivity of 93.3% and specificity of 82.4% as the best cut-off value 3.10.Conclusion PVPI can evaluate the severity of ALI patients in the early stage, and can be used as one of the reference index for ARDS prediction.