急性呼吸窘迫综合征患者血清CC-16、SP-D水平变化及临床意义

Changes and clinical significance of serum CC-16 and SP-D levels in patients with acute respiratory distress syndrome

目的观察急性呼吸窘迫综合征(ARDS)患者血清Clara细胞蛋白-16(CC-16)、肺表面活性蛋白D(SP-D)水平变化,并探讨其临床意义。方法选择97例ARDS患者为病例组,以氧合指数作为参照,根据病情严重程度将患者分为轻度组(n=47)、中度组(n=31)和重度组(n=19);并于同期随机选取60例健康体检者为对照组。采用酶联免疫吸附法检测各组血清CC-16、SP-D水平,随访观察病例组患者28 d生存和死亡情况,采用受试者工作特征(ROC)曲线评估血清CC-16、SP-D水平对ARDS患者短期预后的预测价值。结果病例组血清CC-16、SP-D水平较对照组高(P均<0.01)。中度组和重度组患者血清CC-16、SP-D水平较轻度组高(P均<0.01),重度组较中度组高(P均<0.01)。28 d内共38例ARDS患者死亡,死亡患者血清CC-16、SP-D水平高于生存者(P均<0.01)。CC-16预测ARDS患者28 d生存/死亡的ROC曲线下面积(AUC)为0.853(95%CI:0.773~0.933),SP-D预测的AUC为0.846(95%CI:0.766~0.926),CC-16联合SP-D预测的AUC为0.949(95%CI:0.905~0.994)。结论CC-16、SP-D在ARDS患者血清中水平升高,并且与病情严重程度相关,早期联合检测可作为预测ARDS短期预后的重要标志物。

Objective To explore the expression of Clara cell protein-16(CC-16)and surfactant protein D(SP-D)in patients with acute respiratory distress syndrome(ARDS)and its clinical significance.Methods The clinical data of 97 patients with ARDS(case group)were retrospectively analyzed.Taking PaO 2/FiO 2 as a reference,the patients were divided into the mild group(n=47),moderate group(n=31)and severe group(n=19)according to the severity of the disease.Meanwhile,the patients were divided into the survival group(n=59)and death group(n=38)according to the short-term prognosis(28 d).At the same time,60 healthy volunteers were selected as the control group.The serum levels of CC-16 and SP-D were measured by enzyme-linked immunosorbent assay in each group.We used the receiver operating characteristic(ROC)curve(AUC)to evaluate the predictive value of serum CC-16 and SP-D levels for the short-term prognosis of ARDS patients.Results The levels of serum CC-16 and SP-D in the case group were higher than those in the control group(both P<0.05).The levels of CC-16 and SP-D in the moderate group and severe group were higher than those in the mild group,which in the severe group were higher than those of the moderate group(both P<0.05).The levels of serum CC-16 and SP-D in the death group were higher than those in the survival group(both P<0.05).CC-16 and SP-D had certain value in predicting the 28-day prognosis of ARDS patients.The combined predictive AUC was 0.949(95%CI:0.905-0.994),the sensitivity and specificity were 0.93 and 0.87 respectively,and the accuracy was 0.89.Conclusions The abnormal elevation of CC-16 and SP-D is involved in the pathogenesis of ARDS and is closely related to the severity of the disease.Early combined detection can be used as important makers for predicting the short-term prognosis of ARDS.