血浆可溶性血管内皮生长因子受体1在重症肺炎患者中的诊断与预测价值

Diagnosis and predictive value of plasma soluble vascular endothelial growth factor receptor-1 in patients with severe pneumonia

目的:探讨血浆可溶性血管内皮生长因子受体1(s FLT-1)在重症肺炎患者中的变化及预测价值。方法:选取2013年10月至2016年4月入住郑州大学附属郑州中心医院呼吸重症医学科的重症肺炎患者60例(A组)、重症肺炎合并感染性休克患者60例(B组)、重症肺炎合并MODS患者60例(C组),选取同期入住呼吸内科的社区获得性肺炎患者60例作为对照组(D组)。比较各组患者入院第1、3、7天以及存活组(n=96)和死亡组(n=84)s FLT-1水平变化,分析血浆s FLT-1在重症肺炎中的预测价值及与APACHEⅡ评分的相关性。结果:4组患者PCT和APACHEⅡ评分比较,差异有统计学意义(P均<0.05)。A、B、C 3组患者血浆s FLT-1水平比较,差异有统计学意义,且A、B、C 3组第7天均低于第1天(P均<0.05)。重症肺炎死亡组s FLT-1水平高于存活组(P<0.001)。重症肺炎患者s FLT-1水平和APACHEⅡ评分有关(r=0.647,P<0.001)。s FLT-1预测重症肺炎和28 d病死率的敏感度及特异度分别为77.8%、75.0%和69.7%、80.1%,AUC分别为0.787(95%CI=72.6%~84.8%,P<0.001)和0.775(95%CI=70.5%~84.5%,P<0.001)。结论:血浆s FLT-1水平可以预测重症肺炎和28 d病死率。

Aim ： To explore the diagnosis and predictive value of plasma soluble vascular endothelial growth factor re- eeptor-I （sFLT-1） in patients with severe pneumonia. Melhods： A total of 60 patients with severe pneumonia（ group A） , 60 patients with severe pneumonia-related septic shock （group B ） and 60 patients with severe pneumonia-related MODS （group C） in RICU of Affiliated Zhengzhou Central Hospital of Zhengzhou University were admitted from October 2013 to April 2016 in the study. Sixty eases of common community-aequired pneumonia in Department of Respiratory Medieine were included for comparison（group D）. Plasma sFLT-I was measured on the lst,3rd and 7th day respectively. The association of sFLT-1 with APACHE Ⅱ score and predictive value of sFLT-1 for severe pneumonia were analyzed. Results： The differenees were significant in the levels of PCT and APACHE Ⅱ score among the 4 groups（ P 〈 0.05 ）. There were signifi- cant differences in plasma sFLT-1 among group A,B and C, and sFLT-1 was the lowest on the 7th day in group A,B and C （P 〈 0.05 ）. Non-survivors of severe pneumonia had higher plasma sFLT-1 levels than survivors （ P 〈 0. 001 ）. Plasma sFLT-1 level correlated with the APACHE Ⅱ score（ r = 0. 647,P 〈 0. 001 ）. sFLT-I was used for diagnosis of severe pneu- monia and predict the mortality for 28 d,and the sensitivity and the specificity was 77.8% ,75.0% and 69.7% ,80.1% , respectively. AUC was 0. 787 （95% CI = 72.6% - 84.8% ,P 〈 0. 001） and 0. 775 （95% CI = 70.5% - 84.5% ,P 〈 0. 001 ） ,respectively. Conclusion： Plasma sFLT-1 level could predict severe pneumonia and mortality for 28 d.