血清ANGPTL4水平对急性呼吸窘迫综合征患者疾病严重程度和预后的预测价值

Predictive value of serum ANGPTL4 level on disease severity and prognosis in patients with acute respiratory distress syndrome

目的 探讨血清血管生成素样4(ANGPTL4)水平对急性呼吸窘迫综合征(ARDS)患者疾病严重程度和预后的预测价值。方法 前瞻性选择2019年6月至2021年6月于江苏省张家港市第五人民医院呼吸内科就诊的ARDS患者共128例为研究对象,以氧合指数(PaO/FiO)不同水平进行分组,即46例轻度组(>200~300 mm Hg)、50例中度组(>100~200 mm Hg)和32例重度组(≤100 mm Hg),另选择42例健康志愿者为对照组。根据治疗28 d预后将ARDS患者分为存活组(85例)和死亡组(43例)。结果 重度组急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分、血清ANGPTL4、、白细胞介素(IL)-6和肿瘤坏死因子-α(TNF-α)水平显著高于中度组(P<0.05),中度组高于轻度组(P<0.05),轻度组高于对照组(P<0.05)。死亡组APACHEⅡ评分和SOFA评分、ANGPTL4水平显著高于存活组(P<0.05),PaO/FiO显著低于存活组(P<0.05)。Cox风险比例模型显示,APACHEⅡ评分(HR=2.124,95%CI=1.812~2.523,P<0.001)、SOFA评分(HR=2.323,95%CI=1.914~2.627,P<0.001)、PaO/FiO(HR=0.469,95%CI=0.201~0.856,P=0.003)和ANGPTL4(HR=1.526,95%CI=1.127~2.232,P<0.001)是ARDS患者死亡的预测因子。受试者工作特征曲线显示,APACHEⅡ评分、SOFA评分、PaO/FiO和ANGPTL4评估患者死亡风险的曲线下面积分别为0.785(95%CI=0.732~0.843,P=0.001)、0.811(95%CI=0.754~0.853,P<0.001)、0.832(95%CI=0.776~0.868,P<0.001)和0.889(95%CI=0.816~0.935,P<0.001)。结论 血清ANGPTL4异常表达可能参与了ARDS的发生、发展并影响患者临床预后,早期检测ANGPTL4对评估患者疾病严重程度和预后具有重要价值。

Objective To investigate the predictive value of serum angiopoietin like 4(ANGPTL4) level on disease severity and prognosis in patients with acute respiratory distress syndrome(ARDS).Methods A total of 128 patients with ARDS in department of respiratory medicine of Zhangjiagang Fifth People′s Hospital from June 2019 to June 2021 were prospectively enrolled. According to the oxygenation index(PaO/FiO),they were divided into mild group(n=46,>200-300 mm Hg),moderate group(n=50,>100-200 mm Hg)and severe group(n=32,≤100 mm Hg).Meanwhile, 42 healthy people were chosed as the control group. According to the prognosis of 28 days, ARDS patients were divided into survival group(n=85)and death group(n=43).Results The acute physiology and chronic health score Ⅱ(APACHE Ⅱ),sequential organ failure assessment(SOFA) score and serum levels of ANGPTL4,interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in severe group were significantly higher than those in moderate group(P<0.05),the moderate group were significantly higher than those in mild group(P<0.05),and the mild group were significantly higher than those in control group(P<0.05). What′s more, APACHEⅡ score, SOFA score and ANGPTL4 in death group were significantly higher than those in survival group(P<0.05),while PaO/FiOwas lower(P<0.05). Cox risk proportional model found that APACHEⅡ score(HR=2.124,95%CI=1.812-2.523,P<0.001),SOFA score(HR=2.323,95%CI=1.914-2.627,P<0.001),PaO/FiO(HR=0.469,95%CI=0.201-0.856,P=0.003) and ANGPTL4( HR=1.526,95%CI=1.127-2.232,P<0.001) were the risk factors for death in ARDS patients(P<0.05). Receiver operating characteristic curve showed that the area under the curve of APACHEⅡ score, SOFA score, PaO/FiOand ANGPTL4 in predicting death were 0.785(95%CI=0.732-0.843,P<0.001),0.811(95%CI=0.754-0.853,P=0.001),0.832(95%CI=0.776-0.868,P<0.001) and 0.889(95%CI=0.816-0.935,P<0.001).Conclusion The abnormal expression of serum ANGPTL4 may be involved in the occurrence and development of ARDS and could affect the clinical prognosis of patients. Early detection of ANGPTL4 has important value in evaluating the degree of disease and the prognosis of patients.