血清KL-6、sTM、CC-16对脓毒症并发急性呼吸窘迫综合征患者预后的价值研究

The predictive value of serum KL-6,sTM and CC-16 in patients with sepsis complicated with acute respiratory distress syndrome

目的:探讨血清KL-6、可溶性血栓调节蛋白(sTM)、Clara细胞分泌蛋白-16(CC-16)对脓毒症并发急性呼吸窘迫综合征(ARDS)患者预后的价值。方法:选择2017-02-2019-02期间我院呼吸科重症监护室收治的169例脓毒症并发ARDS患者,根据入院24 h内评估氧合指数(PaO2/FiO2)分为轻度组(43例)、中度组(69例)、重度组(57例),根据患者入院后28 d内生存状况将其分为死亡组(70例)、存活组(99例)。采用酶联免疫吸附试验检测血清KL-6、sTM、CC-16水平,收集患者临床资料,采用Logistic回归分析影响脓毒症并发ARDS患者预后的因素,受试者工作特征曲线(ROC)分析血清KL-6、sTM、CC-16、联合KL-6+sTM+CC-16预测脓毒症并发ARDS患者预后的价值。结果:血清KL-6、sTM、CC-16水平随着ARDS病情严重程度加重而升高(P<0.05),死亡组血清KL-6、sTM、CC-16水平高于存活组(P<0.05)。Logistic回归分析结果显示入院24 h内高APACHEⅡ评分、低PaO2/FiO2、高血清KL-6、sTM、CC-16水平是脓毒症并发ARDS患者预后不良的危险因素(P<0.01)。ROC分析结果显示血清KL-6、sTM、CC-16、联合KL-6+sTM+CC-16预测脓毒症并发ARDS患者预后的曲线下面积(AUC)分别为0.698、0.750、0.670、0.926,敏感度分别为71.43%、74.29%、67.14%、91.43%,特异度分别为71.72%、75.76%、68.69%、91.92%。结论:脓毒症并发ARDS患者血清KL-6、sTM、CC-16水平均升高,高水平KL-6、sTM、CC-16与病情严重程度和不良预后的发生密切相关,可为临床预后判断提供参考。

Objective:To investigate the prognostic value of serum KL-6,soluble thrombus regulatory protein(sTM),Clara cell protein-16(CC-16)in patients with sepsis complicated with acute respiratory distress syndrome(ARDS).Method:One hundred and sixty-nine patients with sepsis complicated with ARDS from February 2017 to February 2019 in our respiratory intensive care unit were enrolled.They were divided into mild group(43 cases),moderate group(69 cases),severe group(57 cases)according to the oxygenation index(PaO2/FiO2)assessed within 24 h after admission,and into death group(70 cases),survival group(99 cases)according to survival status within 28 d after admission.Serum levels of KL-6,sTM and CC-16 were detected by ELISA,and clinical data was collected.Logistic regression was used to analyze the factors affecting the prognosis.ROC was used to analyze the prognostic value of serum KL-6,sTM,CC-16 and the combination of KL-6,sTM,and CC-16 in predicting the prognosis of patients with sepsis complicated with ARDS.Result:The serum levels of KL-6,sTM and CC-16 increased with the aggravation of ARDS(P<0.05),and they were higher in the death group than those in the survival group(P<0.05).Logistic regression analysis results showed that high APACHEⅡscore within 24 h after admission,low PaO2/FiO2,high serum KL-6,sTM,CC-16 levels were risk factors for poor prognosis in sepsis patients complicated with ARDS(P<0.01).ROC analysis results showed that the AUC of serum KL-6,sTM,CC-16,combination of KL-6,sTM and CC-16 were 0.698,0.750,0.670,0.926,respectively.And the sensitivity and the specificity were 71.43%,74.29%,67.14%,91.43%and 71.72%,75.76%,68.69%,91.92%,respectively.Conclusion:Serum levels of KL-6,sTM,and CC-16 in patients with sepsis complicated with ARDS are all elevated.This has high levels of KL-6,sTM,and CC-16 are closely related to the severity of the disease and the occurrence of adverse prognosis,which can provide reference for clinical prognosis judgment.