脓毒症并发急性呼吸窘迫综合征患者血清SDC-1的水平表达及其临床意义

Expression of SDC-1 in Serum of Patients with Sepsis Associated Acute Respiratory Distress Syndrome and Its Clinical Significance

目的探讨血清多配体蛋白聚糖1(syndecan 1,SDC-1)与脓毒症并发急性呼吸窘迫综合征(sepsis associated acute respiratory distress syndrome,SARDS)患者病情严重程度以及预后情况的关系。方法选取2018年3月~2021年3月在北部战区总医院接受治疗的SARDS患者98例,根据病情严重程度将其分为轻度组(n=31)、中度组(n=35)和重度组(n=32);另根据患者的生存情况将其分为存活组(n=56)和死亡组(n=42)。收集所有患者的一般资料,记录氧合指数(oxygenation index,PaO_(2)/FiO_(2))、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学及慢性健康状况评分II(acute physiology and chronic health evaluation ii,APACHE II)以及肺损伤评分(lung injury score,LIS)。采用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)检测血清SDC-1的水平,并采用SPSS21进行统计学分析。结果重度组、中度组和轻度组的SOFA评分(11.70±3.26,9.32±2.48,7.49±2.31)、APACHEII评分(27.58±4.32,23.15±3.86,16.94±3.67)、LIS评分(2.75±0.26,2.06±0.28,1.41±0.23)、SDC-1(632.98±71.49 ng/ml,514.37±68.54 ng/ml,403.21±50.36 ng/ml)依次降低,PaO_(2)/FiO_(2)依次升高(84.32±10.59 mmHg,164.87±29.38 mmHg,256.57±25.49mmHg),差异均有统计学意义(F=11.120,57.325,211.713,100.242,442.532,均P<0.05)。死亡组的年龄(65.31±9.64岁)、SOFA评分(11.12±3.18)、APACHE II评分(24.46±4.17)、LIS评分(2.29±0.26)、SDC-1(599.34±74.36 ng/ml)高于存活组(61.47±8.69岁,8.32±2.78,21.26±3.81,1.92±0.27,456.88±69.15 ng/ml),PaO_(2)/FiO_(2)低于存活组(142.78±19.38 vs 186.17±30.52),差异均有统计学意义(t=2.065,4.638,3.951,6.820,9.772,8.069,均P<0.05)。SARDS患者血清SDC 1水平与PaO_(2)/FiO_(2)呈负相关(r=-0.497,P<0.05),与SOFA评分、APACHE II评分和LIS评分呈正相关(r=0.316,0.308,0.512,均P<0.05);血清SDC-1对SARDS患者生存情况的预测价值较高,曲线下面积为0.875(95%CI:0.807~0.943)。结论血清SDC-1水平与SARDS患者病情严重程度以及预后情况密切相关,且对SARDS患者的预后情况有较高的预测价值。

Objective To investigate the relationship between serum syndecan-1(SDC-1)and the severity and prognosis of patients with sepsis associated acute respiratory distress syndrome(SARDS).Methods 98 patients with SARDS who were treated in Northern Theater General Hospital from March 2018 to March 2021 were selected and divided into mild group(n=31),moderate group(n=35)and severe group(n=32)according to the severity of the disease,the patients were divided into survival group(n=56)and death group(n=42)according to their survival.The general data of all patients were collected and oxygenation index(PaO_(2)/FiO_(2)),sequential organ failure assessment(SOFA),Acute Physiology and Chronic Health evaluation II(APACHE II)and lung injury score(LIS)were recorded.The level of serum SDC-1 was detected by enzyme linked immunosorbent assay(ELISA),and statistically analyzed by SPSS21.Results The SOFA score(11.70±3.26,9.32±2.48,7.49±2.31),APACHE II score(27.58±4.32,23.15±3.86,16.94±3.67),LIS(2.75±0.26,2.06±0.28,1.41±0.23)score and SDC-1(632.98±71.49 ng/ml,514.37±68.54 ng/ml,403.21±50.36 ng/ml)of the severe group,moderate group and mild group decreased in turn,and PaO_(2)/FiO_(2)increased in turn(84.32±10.59 mmHg,164.87±29.38 mmHg,256.57±25.49mmHg),the differences were statistically significant(F=11.120,57.325,211.713,100.242,442.532,all P<0.05).The age(65.31±9.64year),SOFA score(11.12±3.18),APACHE II score(24.46±4.17),LIS score(2.29±0.26)and SDC-1(599.34±74.36ng/ml)of the death group were higher than those of the survival group(61.47±8.69 year,8.32±2.78,21.26±3.81,1.92±0.27,456.88±69.15 ng/ml),and PaO_(2)/FiO_(2) were lower than the survival group(142.78±19.38 vs 186.17±30.52),the differences were statistically significant(t=2.065,4.638,3.951,6.820,9.772,8.069,all P<0.05).Serum SDC-level in patients with SARDS was negatively correlated with PaO_(2)/FiO_(2)(r=-0.497,P<0.05),and positively correlated with SOFA score,APACHE II score and LIS score(r=0.316,0.308,0.512,all P<0.05).Serum SDC-1 had a high predictive value for survival of patients with sards,the area under the curve was 0.875(95%CI:0.807~0.943).Conclusion The level of serum SDC-1 is closely related to the severity and prognosis of SARS patients,and has a high predictive value for the survival of SARS patients.