多糖包被损害评估重症胰腺炎呼吸窘迫综合征发病风险

Evaluation of the Endothelial Glycocalyx Damage in the Risk Assessment of Severe Acute Pancreatitis and Acute Respiratory Distress Syndrome

目的研究多糖包被损害在重症急性胰腺炎(SAP)急性呼吸窘迫综合征(ARDS)发病风险评估中的价值。方法纳入2019年4~11月所有入住昆明医科大学第二附属医院ICU的重症急性胰腺炎患者37例,分为ARDS组13例,AKI组11例,SHOCK组13例。以入ICU时间为入室点,发生器官功能障碍时为0 h点,之后12 h、24 h和48 h分别为12 h点、24 h点、48 h点并采集静脉血。测定各时间点血浆中透明质酸(HA)、硫酸类肝素(HS)、多配体蛋白聚糖-1 (SDC-1)的浓度水平。ARDS组记录机械通气时间。结果在0 h点,ARDS组HA水平均高于AKI组和SHOCK组(P <0.05);合并AKI组、SHOCK组为非ARDS组,ARDS组SDC-1和HA水平均高于非ARDS组(P <0.05)。ARDS组0 h点HA水平与患者机械通气时间呈线性相关(R2=0.819 5)。结论 (1)动态监测血浆HA、SDC-1水平可能有助于SAP并发ARDS的早期预警;(2) SAP患者ARDS出现时的HA水平越高后续机械通气时间可能越长。

Objective To investigate the value of the endothelial glycocalyx layer damage in the risk assessment of acute respiratory distress syndrome in patients with severe acute pancreatitis.Methods 37 patients with severe acute pancreatitis who were admitted to the ICU of our hospital from April to November 2019 were chosen.They were divided into 13 cases in the ARDS group,11 cases in the AKI group,and 13 cases in the SHOCK group.The time when the patients entered the ICU was set as the starting point,and the time when the single or multiple organ insufficiency occurred was defined as 0 h,and the 12 h,24 h,and 48 h.Venous blood was collected at 12 h,24 h and 48 h points,respectively.The concentrations of hyaluronic acid,heparan sulfate and syndecan-1 in plasma were measured at each time for correlation analysis.The time of mechanical ventilation of the ARDS group was recorded.Results The hyaluronic acid level in ARDS group was higher than those in the AKI group and SHOCK group at 0 h(P<0.05).When AKI group and SHOCK were combined into non-ARDS group,the level of hyaluronic acid and the level of syndecan-1 were higher than those in the non-ARDS group(P<0.05).In the ARDS group,the plasma level of hyaluronic acid at 0h was linearly correlated with the number of days of mechanical ventilation(R2=0.8195).Conclusion(1)Dynamic monitoring of plasma hyaluronic acid and syndecan-1 levels is helpful for early warning of SAP concurrent ARDS.2.The higher the HA level at the time of ARDS in SAP patients,the longer the subsequent mechanical ventilation time may be.