血清肺泡表面活性蛋白浓度预测PPCs中危患者腹部手术PPCs的准确性

Accuracy of serum surfactant protein concentration in predicting PPCs in patients at moderate risk for PPCs undergoing abdominal surgery

目的评价血清肺泡表面活性蛋白(SPs)浓度预测术后肺部并发症(PPCs)中危患者腹部手术PPCs的准确性。方法择期腹部胃肠道手术患者58例,预计加泰罗尼亚外科患者呼吸风险评估(ARISCAT)评分26~44分,性别不限,于术前(T0)、拔除气管导管后30 min(T1)和术后1 d(T2)时采集中心静脉血样,采用ELISA法测定血清SP-A和SP-B浓度。记录术后住院期间PPCs发生情况,根据是否发生PPCs分为PPCs组和无PPCs组。采用ROC曲线分析血清SP-A和SP-B浓度预测PPCs的准确性。结果与T0时比较,PPCs组T1时血清SP-B浓度升高,2组T2时血清SP-A、SP-B浓度降低(P<0.05);与T1时比较,2组T2时血清SP-A、SP-B浓度降低(P<0.05);与无PPCs组比较,PPCs组T0时血清SP-A浓度、T1时血清SP-B浓度升高(P<0.05)。T1时血清SP-B浓度预测患者PPCs的ROC曲线下面积(AUC)为0.908(95%置信区间0.821~0.996),截断值为26.3 ng/ml,灵敏度为0.90,特异度为0.81。结论气管拔管后30 min时血清SP-B浓度预测PPCs中危患者腹部手术PPCs的准确性较高。

Objective To evaluate the accuracy of serum surfactant protein concentration in predicting postoperative pulmonary complications(PPCs)in the patients at moderate risk for PPCs undergoing abdominal surgery.Methods Fifty-eight patients of both sexes,with the predicted ARISCAT score of 26-44 points,scheduled for elective abdominal gastrointestinal surgery,were studied.Central venous blood samples were collected before operation(T0),at 30 min after extubation(T1)and at 1 day after surgery(T2)for determination of serum surfactant protein A(SP-A)and surfactant protein B(SP-B)in serum by enzyme-linked immunosorbent assay.The occurrence of PPCs during the postoperative hospitalization was recorded.The patients were divided into PPCs group and non-PPCs group according to whether PPCs occurred.The receiver operating characteristic curve was used to analyze the accuracy of serum SP-A and SP-B concentrations in predicting PPCs.Results Compared with the baseline value at T0,the serum SP-B concentrations were significantly increased at T1 in group PPCs,and the concentrations of serum SP-A and SP-B were significantly decreased at T2 in both groups(P<0.05).The concentrations of serum SP-A and SP-B were significantly decreased at T2 than at T1 in both groups(P<0.05).Compared with non-PPCs group,the serum concentrations of SP-A at T0 and SP-B at T1 were significantly increased in group PPCs(P<0.05).The area under the receiver operating characteristic curve of serum SP-B concentrations in predicting PPCs at T1 was 0.908(95% confidence interval 0.821-0.996),and the cut-off value was 26.3 ng/ml,sensitivity 0.90,and specificity 0.81.Conclusion The accuracy of serum SP-B concentrations measured at 30 min after extubation in predicting PPCs is higher in the patients at moderate risk for PPCs undergoing abdominal surgery.