APACHE Ⅱ评分和血管性血友病因子对急性呼吸窘迫综合征肺损伤程度及预后的评估价值

The Predictive Value of APACHEⅡ Score and von Willebrand Factor on Severity and Prognosis of Acute Respiratory Distress Syndrome

目的探讨急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和血浆血管性血友病因子(v WF)对急性呼吸窘迫综合征(ARDS)肺损伤程度及预后的评估价值。方法选取2010年1月至2012年5月收治的ARDS患者作为研究对象,并检测患者诊断为ARDS后第1 d和第3 d APACHEⅡ评分和血浆v WF水平,将患者按预后分为存活组和死亡组,分析APACHEⅡ评分和血浆VWF水平与患者预后的相关性。计算患者肺损伤评分,并与APACHEⅡ评分和血浆v WF水平进行相关性分析。采用受试者工作特征(ROC)曲线法对APACHEⅡ评分和v WF诊断ARDS死亡的准确率进行分析。结果本研究共纳入ARDS患者112例。在诊断ARDS后第1 d,存活组患者v WF水平及APACHEⅡ评分均显著低于死亡组患者(P<0.05)。在第3 d,存活组患者v WF水平升高,而APACHEⅡ评分下降,较第1 d时差异有统计学意义(P<0.05),但其水平仍显著低于死亡组第3 d(P<0.05)。存活组第1 d肺损伤评分为(1.7±0.4)分,显著低于死亡组的(2.5±0.6)分,第3 d,存活组肺损伤评分有所下降,而死亡组肺损伤评分显著升高(P<0.05)。第1 d的APACHEⅡ评分和v WF与肺损伤评分之间均存在显著正相关(r=0.75,P<0.05;r=0.79,P<0.05)。第1 d的APACHEⅡ评分和v WF ROC曲线下面积分别为0.91和0.87(P<0.05)。结论 APACHEⅡ评分和血浆v WF水平对ARDS患者肺损伤程度及预后具有较高的诊断价值。

Objective To analyze the predictive value of von Willebrand factor（ v WF） and acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ） score on severity and prognosis of acute respiratory distress syndrome（ ARDS）. Methods The ARDS patients who were admitted between January2010 and May 2012 were recruited in the study. APACHEⅡ score and plasma v WF were detected on the first day and the third day after diagnose of ARDS. The patients were divided into a survival group and a death group according the prognosis. The predictive value of v WF and APACHEⅡ score on prognosis were analyzed by the receiver operating characteristic（ ROC） curve. Lung injury score was calculated and its relationship with v WF and APACHE Ⅱ score were analyzed. Results One-hundred and twelve cases of ARDS were enrolled. There were no significant differences between the survival group and the death group in sex,age,respiration rate,blood pressure,white blood cells,procalcitonin or C-reactive protein（ P〈0. 05）.On the first day after diagnosis of ARDS,the APACHEⅡ score and v WF level of the survival group were significantly lower than those in the death group（ P〈0. 05）. On the third day,the APACHEⅡ score was increased but v WF level declined compared with those on the first day（ P〈0. 05）. On the first day,lung injury score of the survival group was 1. 7 ± 0. 4,significantly lower than that in the death group（ 2. 5 ±0. 6）. On the third day,lung injury score in the survival group decreased,while lung injury score of the death group was significantly increased（ P〈0. 05）. On the first day,v WF and APACHEⅡ score were positively correlated with lung injury score（ r = 0. 75,P〈0. 05; r = 0. 79,P〈0. 05）,respectively. On the first day,the area under the ROC curve of APACHEⅡ score and v WF were 0. 87 and 0. 91,respectively（ P〈0. 05）.Conclusion APACHEⅡ score and v WF have high diagnostic value in evaluating the degree of lung injury and predicting the prognosis of patients with ARDS.