急性呼吸窘迫综合征患者血清sCD14和LBP水平变化及其临床意义

Changes in levels of serum sCD14 and LBP in patients with acute respiratory distress syndrome and their clinical significance

目的观察急性呼吸窘迫综合征(ARDS)患者血清可溶性白细胞分化抗原14(sCD14)、脂多糖结合蛋白(LBP)水平变化,并探讨其临床意义。方法选择ARDS患者153例,根据氧合指数(PaO2/FiO2)分为轻度组67例、中度组49例、重度组37例;治疗后随访28 d,存活93例、死亡60例。同期随机选择健康体检者45例(对照组)。ARDS患者入院次日,健康志愿者体检当日,采集肘静脉血,采用ELISA法检测血清sCD14、LBP。采用Pearson积矩相关分析法分析ARDS患者血清sCD14、LBP水平与PaO2/FiO2的关系。采用受试者工作特征(ROC)曲线评估血清sCD14、LBP单独或联合预测ARDS患者预后的效能。结果对照组、轻度组、中度组、重度组血清sCD14、LBP水平逐渐升高,PaO2/FiO2逐渐降低(P均<0.05)。Pearson积矩相关分析显示,ARDS患者血清sCD14、LBP水平与PaO2/FiO2均呈负相关关系(r分别为-0.729、-0.716,P均<0.05)。存活者血清sCD14、LBP水平均低于死亡者(t分别为-5.308、-10.716,P均<0.05)。ROC曲线分析显示,血清sCD14预测ARDS患者死亡的曲线下面积(AUC)为0.855(95%CI:0.797~0.912),cut off值为55.24μg/L,此时其预测ARDS患者死亡的敏感性、特异性和准确性分别为82%、79%、85%;血清LBP预测ARDS患者死亡的AUC为0.834(95%CI:0.773~0.896),cut off值为95.64μg/mL,此时其预测ARDS患者死亡的敏感性、特异性和准确性分别为79%、75%、81%;血清sCD14联合LBP预测ARDS患者死亡的AUC为0.929(95%CI:0.892~0.966),其预测ARDS患者死亡的敏感性、特异性和准确性分别为92%、88%、95%。结论ARDS患者随着病情加重,血清sCD14、LBP水平逐渐升高。血清sCD14、LBP联合检测可用于ARDS早期诊断、病情评估和预后监测。

Objective To observe the changes in levels of serum soluble leukocyte differentiation antigen 14(sCD14)and lipopolysaccharide-binding protein(LBP)in patients with acute respiratory distress syndrome(ARDS),and to explore their clinical significance.Methods Totally 153 patients with ARDS were divided into the mild group of 67 cases,moderate group of 49 cases,and severe group of 37 cases according to oxygenation index(PaO2/FiO2).After 28-day follow-up,93 cases survived and 60 cases died.At the same time,45 healthy volunteers were randomly selected as the control group.On the next day after the admission of ARDS patients,on the day of the physical examination of healthy volunteers,the elbow vein blood was collected,and serum sCD14 and LBP were detected by ELISA.The relationship between serum sCD14,LBP,and PaO2/FiO2 was analyzed by Pearson product moment correlation analysis.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of serum sCD14 and LBP alone or in combination in predicting the prognosis of ARDS patients.Results The serum levels of sCD14 and LBP in the control group,mild group,moderate group,and severe group increased gradually,PaO2/FiO2 decreased gradually(all P<0.05).Pearson product moment correlation analysis showed that the serum levels of sCD14 and LBP were negatively correlated with PaO2/FiO2(r=-0.729,-0.716,respectively,both P<0.05).The serum levels of sCD14 and LBP in the survivors were lower than those in the dead ones(t=-5.308,-10.716,respectively,both P<0.05).The area under the curve(AUC)of sCD14 in predicting the death of ARDS patients was 0.855(95%CI:0.797-0.912),the cut-off value was 55.24μg/L,and the sensitivity,specificity,and accuracy of sCD14 were 82%,79% and 85%,respectively.The AUC of LBP in predicting the death of ARDS patients was 0.834(95%CI:0.773-0.896),the cut-off value was 95.64μg/L,and the sensitivity,specificity,and accuracy were 79%,75%,and 81% respectively.The AUC of serum sCD14 combined with LBP in predicting the death of ARDS patients was 0.929(95%CI:0.892-0.966),and the sensitivity,specificity and accuracy were 92%,88%,and 95%,respectively.Conclusion The serum levels of sCD14 and LBP in patients with ARDS increase with the aggravation of the disease.The combined detection of sCD14 and LBP can be used for early diagnosis,disease assessment and prognosis monitoring of ARDS.