ARDS患者机械功与生物标志物TGF-β1和CTGF相关性分析及其在肺结构重塑中的临床意义

The correlations analysis between mechanical power and biomarker TGF-β1, CTGF in ARDS patients and their clinical significance research in pulmonary structural remodeling

目的探讨急性呼吸窘迫综合征(ARDS)患者机械功与生物标志物TGF-β1、CTGF相关性及其在肺结构重塑中的临床意义以及对患者预后的评估价值.方法选择2017年1月至2019年1月ICU收治的使用有创机械通气治疗的中重度ARDS患者85例,监测记录患者机械功,采用酶联免疫吸附(ELISA)法检测血清转化生长因子-β1(TGF-β1)和结缔组织生长因子(CTGF),并根据高分辨CT(HRCT)检查,将患者分为ARDS组与ARDS肺纤维化组,比较两组患者机械功、TGF-β1及CTGF差异,探讨其相关性,评估血清TGF-β1、CTGF对ARDS肺间质纤维化诊断预测价值,根据所得机械功数值中位数将患者分为高机械功组和低机械功组,分析机械功与患者28 d生存率关系.结果ARDS组机械功(16.91±3.26)J/min、TGF-β1(13.20±5.91)ng/mL,CTGF(44.60±14.82)ng/mL,ARDS肺纤维化组机械功(22.20±4.42)J/min、TGF-β1(22.82±9.97)ng/mL,CTGF(70.18±20.27)ng/mL,两组比较差异有统计学意义(P均<0.001);ARDS患者机械功与血清TGF-β1、CTGF呈显著正相关,相关系数分别为0.411和0.565(P均<0.001);统计分析高机械功组及低机械功组在28 d生存率情况显示,高机械功组生存率为51.06%,低机械功组生存率为72.12%,差异有统计学意义(P<0.05);血清TGF-β1、CTGF对ARDS肺间质纤维化诊断预测的受试者工作特征(ROC)曲线下面积(AUC)分别为0.800、0.837,差异有统计学意义(P<0.05).结论ARDS患者机械功与肺纤维化血清生物标志物TGF-β1、CTGF具有显著相关性,其高低与患者生存预后相关,三者对评估ARDS肺纤维化等肺结构重塑性改变有一定临床价值.

Objective To investigate the clinical correlations between mechanical power and biomarker TGF-β1, CTGF in ARDS patients, and their clinical significance in pulmonary structural remodeling and analyze the evaluation value of prognosis in ARDS patients. Methods Eighty-five patients with moderate or severe ARDS who need mechanical ventilation therapy were randomly selected from hospitalized patients from January 2017 to January 2019. They were monitored and recorded mechanical power, and their serum lung fiber maikers TGF-β1, CTGF were detected by ELISA. According to the HRCT examination, the patients were divided into the ARDS group and the ARDS pulmonary fibrosis group. The differences in mechanical power, TGF-β1 and CTGF between the two groups were compared;their relevance was analyzed and TGF-β1 and CTGF was evaluated for the diagnosis of ARDS pulmonary interstitial fibrosis. According to the median value of mechanical power, the patients were divided into high mechanical power group and low mechanical power group, and then were investigated the relationship between mechanical power and patient 28-day survival rate. Results The mechanical power of the ARDS group was (16.91 ± 3. 26) J/min, the TGF-pi was (13. 20 ± 5. 91) ng/mL, the CTGF was (44. 60 ± 14. 82) ng/mL, the mechanical power of the ARDS pulmonary fibrosis group was (22. 20±4.42) J/min, and the TGF-was (22. 82±9. 97) ng/mL, CTGF was (70. 18 ± 20. 27) ng/ml, the difference between the two groups was significant (P < 0.001);There was a significant positive correlation between mechanical power and serum TGF-β1, CTGF in patients with ARDS, and the correlation coefficients were 0. 411 and 0. 565, respectively (P < 0.001). Statistical analysis of the high mechanical power group and low mechanical power group in the 28-day survival rate showed that the high mechanical power group survival rate was 51.06%, and the low mechanical power group survival rate was 72. 12%, the difference was statistically significant (P <0. 05). The area under the ROC curve of TGF-β1 and CTGF for the diagnosis of ARDS pulmonary fibrosis was 0. 800 and 0. 837, respectively, the significance was significant (P <0.05). Conclusion There was a significant correlation between mechanical power and serum fibrosis biomarkers TGF-β1 , CTGF in ARDS patients, and its level was related to the survival prognosis of patients. The three were clinically evaluated for the assessment of lung structural remodeling such as ARDS pulmonary fibrosis. The three indicators have significant clinical value in evaluating the changes of lung structure remodeling such as ARDS pulmonary fibrosis.