脓毒症相关急性呼吸窘迫综合征患者血清Lac、D-D、sTM、ESM-1的表达及其临床意义

Expression of Serum Lac,D-D,sTM,ESM-1 and Their Clinical Significance in Patients With Sepsis-Related Acute Respoiiratory Distress Syndrome

目的:探讨脓毒症相关急性呼吸窘迫综合征(ARDS)患者血清乳酸(Lac)、D-二聚体(D-D)、可溶性血栓调节蛋白(sTM)、内皮细胞特异性分子-1(ESM-1)的表达及其临床意义。方法:选取2020年1月~2022年1月徐州医科大学附属医院重症医学科收治的375例脓毒症相关ARDS患者,根据入院时氧合指数(OI)差异分为轻度组(n=96)、中度组(n=152)和重度组(n=127),比较各组血清Lac、D-D、sTM、ESM-1水平,采用Spearman相关系数分析血清Lac、D-D、sTM、ESM-1与OI的相关性。根据28d内预后将患者分为死亡组(n=137)和存活组(n=238),收集临床资料,采用多因素Logistic回归分析脓毒症相关ARDS患者预后的影响因素。采用受试者工作特征(ROC)曲线分析血清Lac、D-D、sTM、ESM-1对脓毒症相关ARDS患者预后不良的预测价值。结果:轻度组、中度组、重度组血清Lac、D-D、sTM、ESM-1水平依次升高(P<0.05)。Spearman相关性分析结果显示:脓毒症相关ARDS患者的血清Lac、D-D、sTM、ESM-1水平与OI均呈负相关(P<0.05)。死亡组年龄大于存活组,脓毒性休克、ICU停留时间≥10 d、机械通气时间≥3 d比例以及SOFA评分、血清Lac、D-D、sTM、ESM-1水平均高于存活组,OI低于存活组(P<0.05)。多因素Logistic回归分析显示:脓毒性休克、SOFA评分≥13分、血清Lac、D-D、sTM、ESM-1水平较高是脓毒症相关ARDS患者预后不良的危险因素,而OI较高是预后不良的保护因素(P<0.05)。ROC曲线分析结果显示:血清Lac、D-D、sTM、ESM-1联合检测预测脓毒症相关ARDS患者预后不良的AUC为0.907,明显高于各指标单独检测的0.785、0.747、0.796、0.789。结论:血清Lac、D-D、sTM、ESM-1水平升高与脓毒症相关ARDS病情严重程度和预后不良密切相关,对患者预后有一定预测价值。

Objective:To explore the expression of serum lactate(Lac),D-dimer(D-D),soluble thrombomodulin(sTM)and endothelium-specific molecule-1(ESM-1)in patients with sepsis-associated acute respiratory distress syndrome(ARDS)and to investigate their clinical significance.Methods:375 patients with sepsis related ARDS who were treated in the intensive medicine department of the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2022 were selected,they were divided into mild group(n=96),moderate group(n=152)and severe group(n=127)according to the difference of oxygenation index(OI)at admission.The levels of serum lac,D-D,sTM and ESM-1 in each group were compared.The correlation between serum lac,D-D,sTM and ESM-1 and OI was analyzed by Spearman correlation coefficient.According to the prognosis within 28 d,the patients were divided into death group(n=137)and survival group(n=238).The clinical data were collected.The prognostic factors of sepsis related ARDS patients were analyzed by multivariate logistic regression.The predictive value of serum lac,D-D,sTM and ESM-1 on the poor prognosis of patients with sepsis related ARDS was analyzed by receiver operating characteristic(ROC)curve.Results:The levels of serum lac,D-D,sTM and ESM-1 in mild group,moderate group and severe group increased successively(P<0.05).Spearman correlation analysis showed that the levels of serum lac,D-D,sTM and ESM-1 in patients with sepsis related ARDS were negatively correlated with OI(P<0.05).The age of death group was older than that of survival group,the proportion of septic shock,ICU stay time≥10 d,mechanical ventilation time≥3 d,SOFA score,serum lac,D-D,sTM and ESM-1 were higher than those of survival group,and OI was lower than that of survival group(P<0.05).Multivariate logistic regression analysis showed that septic shock,SOFA score≥13 and high levels of serum lac,D-D,STM and ESM-1 were the risk factors of poor prognosis in patients with sepsis related ARDS,while high OI was the protective factor of poor prognosis(P<0.05).The results of ROC curve analysis showed that the AUC of the combined detection of serum lac,D-D,STM and ESM-1 in predicting the poor prognosis of patients with sepsis related ARDS was 0.907,which was significantly higher than that of 0.785,0.747,0.796 and 0.789.Conclusion:Serum Lac,D-D,sTM and ESM-1 levels are closely associated with the severity of disease and poor prognosis in SAARDS patients and can be used as predictors of poor prognosis in sepsis-associated ARDS patients.