RAGE亚型在ARDS患者病情演变及预后评估中的临床价值

Clinical significance of RAGE subsets in the evolution and prognosis of ARDS patients

目的:探讨晚期糖基化终末产物受体(RAGE)亚型在急性呼吸窘迫综合征(ARDS)患者病情演变及预后评估中的临床价值。方法:将我科收治的95例ARDS患者,根据患者28 d病死率分为生存组和死亡组2个亚组。通过酶联免疫吸附试验(ELISA)检测ARDS患者不同时间点上可溶性RAGE(sRAGE)和内源分泌型RAGE(esRAGE)的血浆水平,同时利用脉搏指示持续心输出量(PiCCO)导管监测相对应时间点上血管外肺水指数(ELWI),比较2组患者间血浆sRAGE、esRAGE及ELWI的差异,并观察这三者的动态变化与ARDS病情演变及预后的相关性。结果:和生存组相比,死亡组患者的氧合指数显著下降,Murray肺损伤评分、APACHEⅡ评分及ELWI明显升高(P<0.05)。与生存组相比,死亡组患者血浆sRAGE水平升高且随病程延长进行性升高,而血浆esRAGE与之相反(P<0.05)。Logistic回归分析发现,ARDS严重程度分级、肺顺应性、APACHEⅡ评分、Murray肺损伤评分、sRAGE、esRAGE水平及ELWI是ARDS患者预后的独立风险因素。动态观察发现ARDS患者的ELWI、血浆sRAGE水平早期进行性上升,第3天达到峰值,后呈现逐步下降趋势,而血浆esRAGE与前两者相反。死亡组患者的ΔsRAGE(sRAGED3-sRAGED0)及ΔELWI(ELWID3-ELWID0)也显著高于生存组患者(P<0.05),而死亡组ΔesRAGE(esRAGED3-esRAGED0)低于生存组,但差异无统计学意义。结论:相比较而言,血浆sRAGE水平及其变化趋势能更好的客观反映ARDS患者病情演变和预后情况。

Objective:To explore the clinical values of the receptor for advanced glycation end-products(RAGE)subsets in the prognosis evolution of acute respiratory distress syndrome(ARDS)patients.Method:A total of 95 patients admitted into the ICU who were diagnosed with ARDS in the Second Affiliated Hospital of Nantong University were enrolled.They were divided into the survival group and the non-survival subgroup,according to their mortality within 28 days.The levels of plasma soluble RAGE(sRAGE)and endogenous secretory RAGE(esRAGE)at different time were measured by enzyme-linked immunosorbent assay(ELISA)in ARDS patients.Meanwhile,the extravascular lung water index(ELWI)at corresponding time was monitored by pulse indicator continuous cardiac output(PiCCO)catheter.Then the levels of the plasma sRAGE,esRAGE and ELWI were compared,and the dynamic change of the plasma sRAGE,esRAGE or ELWI of ARDS patients with different clinical outcomes were observed.Result:Compared with the survival subgroup,the oxygenation index for the non-survival subgroup was significantly decreased,while Murray’s lung injury score,APACHEⅡscore and ELWI were significantly increased(P<0.05).Compared with the survival group,the baseline plasma sRAGE level for the non-survival subgroup increased progressively,and the plasma esRAGE level decreased significantly(P<0.05).Logistic regression analysis showed that the Severity of ARDS,Pulmonary compliance,APACHEⅡscore,Murray lung injury score,sRAGE,esRAGE level and ELWI were independent risk factors for the prognostic of ARDS patients.Dynamic observation showed that the ELWI and plasma sRAGE levels of ARDS patients increased progressively in the early phase,peaked on the third day,and decreased gradually soon afterwards,while the plasma esRAGE level was in the opposite direction.Compared with the survival group,the levels ofΔsRAGE(sRAGED3-sRAGED0)andΔELWI(ELWID3-ELWID0)were higher in the non-survival subgroup(P<0.05);but the difference ofΔesRAGE(esRAGED3-esRAGED0)was not statistically significant.Conclusion:Plasma sRAGE levels and their trends of change can be used for prognosis evolution of patients with ARDS.