不同病情急性呼吸窘迫综合征患者血清铁蛋白、血管生成素样蛋白4、降钙素原与白蛋白比值的变化及对预后的评估价值

Changes of Serum Ferritin,Angiopoietin-Like 4,Procalcitonin to Albumin Ratio and Evaluation Value of Prognosis in Patients with Acute Respiratory Distress Syndrome with Different Conditions

目的:探讨不同病情急性呼吸窘迫综合征(ARDS)患者血清铁蛋白、血管生成素样蛋白4(ANGPTL4)、降钙素原与白蛋白比值(PAR)的变化及对预后的评估价值。方法:选取2019年3月至2022年6月四川大学华西第四医院重症医学科收治的109例ARDS患者,根据氧合指数(Pa O2/Fi O2)将患者分为轻度组(200 mm Hg<Pa O2/Fi O2≤300 mm Hg,38例)、中度组(100 mm Hg<Pa O2/Fi O2≤200 mm Hg,42例)、重度组(≤100 mm Hg,29例)。检测所有ARDS患者血清铁蛋白、ANGPTL4水平及PAR,根据患者入院后28 d内生存状况将其分为存活组(69例)、死亡组(40例)。多因素Logistic回归分析ARDS患者入院后28 d内死亡的危险因素。受试者工作特征(ROC)曲线分析血清铁蛋白、ANGPTL4、PAR评估ARDS患者预后的预测价值。结果:重度组血清铁蛋白、ANGPTL4、降钙素原及PAR高于中度组和轻度组(P<0.05),血清白蛋白水平低于中度组和轻度组(P<0.05)。死亡组血清铁蛋白、ANGPTL4、降钙素原及PAR高于存活组(P<0.05),血清白蛋白水平低于存活组(P<0.05)。高SOFA评分、高PAR及血清铁蛋白、ANGPTL4水平升高是ARDS患者入院28 d内死亡的危险因素(P<0.05)。联合血清铁蛋白、ANGPTL4、PAR三项指标预测ARDS患者预后的曲线下面积为0.867,高于单独指标预测的0.775、0.727、0.776。结论:ARDS患者血清铁蛋白、ANGPTL4水平及PAR增高与病情加重以及预后不良有关,联合检测三项指标在ARDS患者预后评估中具有较高价值。

Objective:To investigate the changes of serum ferritin,angiopoietin like protein 4(ANGPTL4),procalcitonin to albumin ratio(PAR)and their evaluation value of prognosis in patients with acute respiratory distress syndrome(ARDS)with different conditions.Methods:109 patients with ARDS who were admitted to the Department of Intensive Care Unit of The Fourth West China Hospital of Sichuan University from March 2019 to June 2022 were selected.According to the oxygenation index(Pa O2/Fi O2),the patients were divided into mild group(200 mm Hg less than Pa O2/Fi O2less than or equal to 300 mm Hg,38 cases),moderate group(100mm Hg less than Pa O2/Fi O2less than or equal to 200 mm Hg,42 cases),severe group(29 cases ess than or equal to 100 mm Hg).The serum ferritin,ANGPTL4 levels and PAR of all patients with ARDS were detected,and the patients were divided into survival group(69cases)and death group(40 cases)according to their survival status within 28 days after admission.Multivariate Logistic regression analysis of the risk factors of death in patients with ARDS within 28 days after admission.The predictive value of serum ferritin,ANGPTL4 and PAR in predicting prognosis of patients with ARDS was analyzed by receiver operating characteristic(ROC)curve.Results:Serum ferritin,ANGPTL4,procalcitonin and PAR in the severe group were higher than those in the moderate group and mild group(P<0.05),and serum albumin level was lower than that in moderate group and mild group(P<0.05).Serum ferritin,ANGPTL4,procalcitonin and PAR in the death group were higher than those in the survival group(P<0.05),and serum albumin level was lower than that in the survival group(P<0.05).High SOFA score,high PAR and elevated serum ferritin and ANGPTL4 levels were risk factors for death in patients with ARDS within 28 days after admission(P<0.05).The area under curve of united serum ferritin,ANGPTL4 and PAR to predict the prognosis of patients with ARDS was 0.867,which was higher than 0.775,0.727 and 0.776 predicted by single indicators.Conclusion:Increased serum ferritin,ANGPTL4 levels and PAR in patients with ARDS are associated with exacerbation of the disease and poor prognosis.United detection of these three indicators is of high value in the prognosis assessment of patients with ARDS.