急性呼吸窘迫综合征患者的生物标志物与严重程度的相关性分析

Correlation analysis of biomarkers and severity in patients with acute respiratory distress syndrome

目的探讨急性呼吸窘迫综合征患者的生物标志物与严重程度的相关性。方法选择2017~2018年根据柏林定义诊断为ARDS而收住ICU的重症患者,入科48 h留取血标本,测定SP-D、IL-8浓度,并收集患者的基本临床数据和实验室指标。结果生存组和死亡组基本资料比较差异无统计学意义(P>0.05)。单因素分析:死亡组乳酸(3.80±1.22)mmol/L、氧合指数(99.91±36.70)mmHg、CRP[120.00(97.15,166.13)]mg/L、PCT[6.79(3.77,19.60)]ng/mL、APACHⅡ评分(26.25±6.82)分、SP-D[6274.39(3127.36,7996.32)]pg/mL、IL-8[61.57(54.13,79.78)]pg/mL差于生存组乳酸(2.50±0.59)mmol/L、氧合指数(173.66±46.92)mmHg、CRP[68.65(31.47,107.75)]mg/L、PCT[1.43(0.88,9.53)]ng/mL、APACHⅡ评分(18.83±6.09)分、SP-D[3961.03(1810.23,5053.25)]pg/mL、IL-8[22.53(15.81,26.75)]pg/mL,两组比较有统计学意义(P<0.05)。生存组和死亡组多因素分析:氧合指数、APACHⅡ评分为ARDS患者死亡的独立危险因素(OR=1.034,95%CI=1.000~1.069,P=0.048;OR=0.093,95%CI=1.005~1.450,P=0.044)。轻度、中度、重度ARDS患者血液SP-D、IL-8浓度逐渐增高,三组比较差异有统计学意义(F=109.090,P=0.000;F=9.544,P=0.002)。根据柏林定义,以氧合指数作为严重程度的指标,结果显示,SP-D、IL-8浓度和氧合指数均呈负相关(r=-0.680,P=0.001;r=-0.763,P=0.000)。结论ARDS患者的血SP-D和IL-8的浓度升高,且浓度随病情加重而升高。因此,血SP-D和IL-8可能成为ARDS的生物标志物,且可反映ARDS疾病的严重程度,为ARDS的治疗和预防提供依据。

Objective To investigate the correlation between biomarkers and severity in patients with acute respiratory distress syndrome.Methods The severely ill patients diagnosed with ARDS according to the Berlin definition and admitted to ICU from 2017 to 2018 were selected.Blood samples were collected within 48 hours after admission.SP-D and IL-8 concentrations were measured.Basic clinical data and laboratory indicators were collected.Results There was no significant difference in basic data between the survival group and the death group(P>0.05).Univariate analysis showed that lactic acid(3.80±1.22)mmol/L,oxygenation index(99.91±36.70)mmHg,CRP(120.00[97.15,166.13])mg/L,PCT(6.79[3.77,19.60])ng/mL,APACHⅡscore(26.25±6.82),SP-D(6274.39[3127.36,7996.32])pg/mL,and IL-8(61.57[54.13,79.78])pg/mL in the death group was worse than the lactic acid(2.50±0.59)mmol/L,oxygenation index(173.66±46.92)mmHg,CRP(68.65[31.47,107.75])mg/L,PCT(1.43[0.88,9.53])ng/mL,APACHⅡscore(18.83±6.09),SP-D(3961.03[1810.23,5053.25])pg/mL,and IL-8[22.53(15.81,26.75)]pg/mL in the survival group,and the difference between the two groups were statistically significant(P<0.05).Multivariate analysis of survival group and death group showed that the oxygenation index and APACHⅡscore were independent risk factors for death in ARDS patients(OR=1.034,95%CI=1.000-1.069,P=0.048;OR=0.093,95%CI=1.005-1.450,P=0.044).The blood SPD and IL-8 concentrations of patients with mild,moderate,and severe ARDS gradually increased,and the difference between the three groups was statistically significant(F=109.090,P=0.000;F=9.544,P=0.002).According to the Berlin definition,the oxygenation index is used as an indicator of severity.The results showed that SP-D,IL-8 concentration and oxygenation index were all negatively correlated(r=-0.680,P=0.001;r=-0.763,P=0.000).Conclusion The blood SP-D and IL-8 concentration in patients with ARDS increases,and the concentration increases with the disease's severity.Therefore,the blood SP-D and IL-8 may become the biomarkers of ARDS and reflect the severity of ARDS,which provides a basis for the treatment and prevention of ARDS.