5种生物标志物对ARDS预后的预测分析

Prognostic analysis of 5 biomarkers for acute respiratory distress syndrome

目的 分析5种生物标志物干扰素诱导的解旋酶C域蛋白1(interferon-induced helicase C domain-containing protein 1, IFIH1)、基因干扰素调节因子1(gene interferon regulatory factor 1, IRF1)、信号传导及转录激活蛋白(signal transducer and activator of transcription, STAT1)、鸟苷结合蛋白1(guanylate binding protein 1, GBP1)、干扰素诱导蛋白与四肽重复序列3(interferon-induced protein with tetratricopeptide repeats 3, IFIT3)对急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)预后的预测。方法 选择2017年1月至2017年12月东南大学附属中大医院重症医学科收治的26例ARDS患者为对象,采集患者外周血行芯片检测,提取5种生物标志物IFIH1、IRF1、STAT1、GBP1、IFIT3表达量。采用单因素Cox回归和受试者工作特征曲线(ROC)评估5种生物标志物和ARDS严重程度与28 d累积病死率相关性。采用多因素COX回归构建联合模型。结果 5种生物标志物表达与ARDS患者28 d累积病死率相关(P<0.05),ARDS严重程度和28 d累计病死率不相关(P>0.05):IFIH1[HR 2.309 95%CI(1.162, 4.590)];IRF1[HR 3.152 95%CI(1.043, 9.528)];IFIT3[HR 1.793 95%CI(1.103, 2.917)];GBP1[HR 2.342 95%CI(1.087, 5.047)];STAT1[HR 2.492 95%CI(1.388,4.474)];ARDS严重程度[HR 1.665 95%CI(0.598, 4.628)]。5种生物标志物及ARDS严重程度预后预测ROC曲线下面积分别为0.883、0.833、0.900、0.925、0.908、0.625。联合模型对28 d预后预测性为0.950。结论 对ARDS患者预后的预测,5种生物标志物优于柏林标准ARDS严重程度。5种生物标志物构建的模型选出预后不佳的ARDS患者,具有临床意义。

Objective To analyze the prognostics value of 5 biomarkers IFIH1,IRF1,STAT1,GBP1 and IFIT3 in acute respiratory distress syndrome(ARDS).Methods All of 26 ARDS patients admitted to the Department of Critical Care Medicine,Zhongda Hospital Affiliated to Southeast University from January 2017 to December 2017 were included as the study objects.Peripheral blood was collected for microarray detection,and the expression levels of IFIH1,IRF1,STAT1,GBP1,IFIT3 were extracted.The relationship of 5 biomarkers and ARDS severity with 28-day cumulative mortality was examined using univariate Cox regression and receiver operating characteristic curve(ROC),with a cutoff value of P<0.05.In order to create a combined model of the five chemicals and the severity of ARDS,multivariate COX regression was utilized.Results In ARDS patients,expression of five molecules was linked with 28-day cumulative mortality(P<0.05)according to a univariate COX regression analysis,but not with ARDS severity(P>0.05):IFIH1[HR 2.30995%CI(1.162,4.590)];IRF1[HR 3.15295%CI(1.043,9.528)];IFIT3[HR 1.79395%CI(1.103,2.917)];GBP1[HR 2.34295%CI(1.087,5.047)];STAT1[HR 2.49295%CI(1.388,4.474)];ARDS severity[HR 1.66595%CI(0.598,4.628)].According to ROC analysis,the prediction accuracy(area under the ROC curve)of five molecules and the severity of ARDS to 28-day mortality were,respectively,0.883,0.833,0.900,0.925,0.908,and 0.625.With an accuracy of 0.950,the combined model predicted the 28-day mortality.Conclusion Five molecules were more accurate at predicting the prognosis of ARDS patients than the Berlin criteria for ARDS severity.The integrated model based on five molecules can accurately categorize patients with severe ARDS who have a bad prognosis and aid in ARDS therapy.