急性呼吸窘迫综合征患者血清雌二醇水平对血管外肺水的影响

Effect of serum estradiol level on extravascular lung water in patients with acute respiratory distress syndrome

目的探讨急性呼吸窘迫综合征(ARDS)患者血清雌二醇(E2)水平对血管外肺水的影响。方法选取2012年12月-2014年4月在该院中心ICU收治的55例男性ARDS患者,根据住院2周后是否存活分为存活组和死亡组,分别于入院第1、3和7天测定血清E2水平,同期用PICCO监护仪监测肺血管通透性指数(PVPI)和血管外肺水指数(ELWI)的变化。结果 55例ARDS患者中,2周内存活31例,死亡24例;两组患者入院第1天的血清E2、PVPI和ELWI差异无统计学意义(P>0.05);与第1天比较,存活组患者第3天的血清E2无明显变化(P>0.05),PVPI和ELWI均明显升高(P<0.005),死亡组患者的血清E2则明显下降(P<0.05),PVPI和ELWI亦明显升高(P=0.001、0.000);与第3天比较,存活组患者第7天的血清E2出现明显升高(P<0.005),而PVPI和ELWI明显下降(P<0.01),死亡组患者的血清E2则继续显著下降(P<0.01),PVPI和ELWI继续显著升高(P<0.02);两组患者的血清E2水平与PVPI、ELWI呈显著负相关(r=-0.642,P<0.05)。结论 ARDS患者的血清E2水平对血管外肺水可能有一定的影响,其水平高低与血管外肺水呈负相关,可能是判断预后的指标之一。

[Objective] To investigate the effects of serum estradiol level on extravascular lung water （EVLW） in patients with acute respiratory distress syndrome （ARDS）. [Methods] From Dec. 2012 to Apr. 2014, 55 cases of male patients with ARDS were selected in the ICU of our hospital. According to the sur- vival situation 2 weeks after admission the cases were divided into survival group and death group. On day 1, 3 and 7 after admission serum estradiol level was determined, at the same time PICCO monitor was used to monitor pulmonary vascular permeability index （PVPI） and extravascular lung water index （ELWI）. [Results] In the 55 cases of ARDS, 31 cases survived and 24 cases died in 2 weeks. The serum estradiol, PVPI and ELWI on day 1 had no significant difference between both groups （P〉 0.05）. Compared with those on day 1, serum estradiol had no significant change （P〉 0.05）, while the PVPI and ELWI were significantly increased （P 〈 0.005） in the survival group on day 3; the serum estradiol was significantly decreased （P〈 0.05）, while the PVPI and ELWI also significantly increased （P〈0.001） in the death group on day 3. Compared with those on day 3, the serum estradiol significantly increased （P〈0.005）, while PVPI and ELWI significantly declined （P〈 0.01） in the survival group on day 7; the serum estradiol significantly decreased （P〈 0.01）, while the PVPI and ELWI significantly rose （P〈 0.05） in the death group on day 7. In either group the serum estradiol level had negative correlations with PVPI and ELWI （r =-0.642, P 〈 0.05）. [Conclusion] In ARDS patients serum estradiol may have certain influence on extravascular lung water, its level has a negative correlation with EVLW, which may be one of the prognostic indexes for ARDS.