急性呼吸窘迫综合征患者血清HSP70和硫化氢水平变化与预后的关系

Changes of Serum HSP70 and Hydrogen Sulfide Levels in Patients with Acute Respiratory Distress Syndrome and Their Relationships with Prognosis

目的:检测急性呼吸窘迫综合征(ARDS)患者血清热休克蛋白70(HSP70)与硫化氢(H2S)水平,并分析其与该疾病预后的关系.方法:选取2015年5月至2018年5月本院收治的ARDS患者90例,根据是否死亡,将患者分为死亡组(49例)和存活组(41例).采用酶联免疫吸附法(ELISA)检测受试者血清HSP70、H2S水平,利用APACHE-Ⅱ对所有研究对象进行评分,利用血气分析仪检测患者吸入氧浓度(FiO2)与动脉血氧分压(PaO2),计算氧合指数.结果:死亡组患者APACHE-Ⅱ评分显著高于存活组(P<0.05),死亡组患者氧合指数显著低于存活组(P<0.05),死亡组患者中肺外源性ARDS患者人数显著高于存活组(P<0.05);存活组ARDS患者血清H2S、HSP70水平均显著高于死亡组(P<0.05);重度ARDS患者血清H2S、HSP70水平显著低于中度患者(P<0.05),中度ARDS患者血清H2S、HSP70水平显著低于轻度患者(P<0.05);ROC曲线分析显示,血清H2S、HSP70水平单独检测对ARDS患者预后预测具有一定价值;两者联合预测的AUC为0.885,敏感度为77.60%,特异性为92.90%;多因素分析显示,APACHE-Ⅱ评分、氧合指数、血清H2S水平、血清HSP70水平是影响患者预后的独立危险因素.结论:ARDS存活组患者血清H2S、HSP70水平显著升高,氧合指数(PaO2/FiO2)降低、血清H2S水平降低、血清HSP70水平降低是ARDS患者30d全因死亡的危险因素,可能作为ARDS预后的生物标志.

Objective: To detect the levels of serum heat shock protein 70 (HSP70) and hydrogen sulfide (H 2S) in patients with acute respiratory distress syndrome (ARDS), and to analyze their relationships with the prognosis of the disease. Methods: 90 patients with ARDS admitted to our hospital from May 2015 to May 2018 were divided into 49 cases in death group and 41 cases in survival group. Enzyme linked immunosorbent assay (ELISA) was used to detect serum HSP70 and H 2S levels, all subjects were scored by APACHE- II, the inhaled oxygen concentration (FiO2) and arterial partial pressure of oxygen (PaO2) were measured by blood gas analyzer, and the oxygenation index was calculated. Results: The APACHE-II score in the death group was significantly higher than that in the survival group (P<0.05), the oxygenation index in the death group was significantly lower than that in the survival group (P<0.05), the number of extrapulmonary ARDS in the death group was significantly higher than that in the survival group (P<0.05);serum H 2S and HSP70 levels of ARDS patients in the survival group were significantly higher than those in the death group (P<0.05);the serum levels of H 2S and HSP70 in severe ARDS patients were significantly lower than those in moderate ARDS patients (P<0.05), and the serum levels of H 2S and HSP70 in moderate ARDS patients were significantly lower than those in mild ARDS patients (P<0.05);ROC curve analysis showed that serum H 2S and HSP70 levels alone detections had certain values in predicting the prognosis of ARDS patients;the combined detection of AUC was 0.885, sensitivity was 77.60%, specificity was 92.90%;multivariate analysis showed that APACHE-II score, oxygenation index, serum H 2S level, and serum HSP70 level were independent risk factors affecting the prognosis of patients. Conclusion: The serum H 2S and HSP70 levels in ARDS survival group are increased significantly, lower oxygenation index (PaO 2/FiO 2), lower serum H 2S level, and lower serum HSP70 level are risk factors for all-cause mortality in ARDS patients within 30 days, which may be a biomarker of prognosis of ARDS.