急性呼吸窘迫综合征患者血清α1-抗胰凝乳蛋白酶和α1-抗胰蛋白酶表达水平及临床意义

Serum Alpha-1-Antichymotrypsin and Alpha-1-Antitrypsin ExpressionLevels in Patients with Acute Respiratory Distress Syndrome andthe Clinical Significance

目的 探究血清α1-抗胰凝乳蛋白酶(alpha-1-antichymotrypsin,AACT)和α1-抗胰蛋白酶(alpha-1-antitrypsin,AAT)在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中的表达情况及二者的临床意义。方法选取2019年1月~2022年12月四川绵阳四〇四医院收治的84例ARDS患者作为疾病组,另选取同时期在四川绵阳四〇四医院进行体检的84例健康人作为对照组。采用酶联免疫吸附测定法(enzyme linked immunosorbent assay,ELISA)检查血清AACT和AAT表达水平。采用Kaplan-Meier法分析ARDS患者血清AACT和AAT表达与预后的关系。采用COX回归分析ARDS患者预后影响因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清AACT和AAT表达对ARDS患者预后的预测价值。结果 疾病组血清AACT(14.02±2.87ng/ml),AAT(4.76±1.19g/L)表达水平均高于对照组(9.56±2.11ng/ml,2.92±0.24g/L),差异具有统计学意义(t=11.475,13.892,均P <0.05)。ARDS患者中AACT与AAT高表达组生存率[40.00%(18/45),39.02%(16/41)]分别低于AACT与AAT低表达组生存率[84.62%(33/39),81.40%(35/43)],差异具有统计学意义(χ^(2)=17.436,15.797,均P <0.001)。并发下呼吸道感染(HR=3.188,P=0.013)、使用血管活性物质(HR=2.656,P=0.045)、免疫抑制药物(HR=6.118,P=0.001)、发病至治疗时长(HR=5.202,P=0.005)、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health score Ⅱ,APACHE Ⅱ)(HR=5.368,P=0.003)、血清AACT(HR=3.976,P=0.009)和AAT(HR=4.773,P=0.008)水平均为ARDS患者30天死亡的危险因素,氧合指数(oxygenation index,OI)(HR=0.402,P=0.007)、有创机械通气时间(HR=0.461,P=0.013)为保护因素(P <0.05)。血清AACT与AAT联合预测ARDS患者预后不良的ROC曲线下面积(area under the curve,AUC)(95%CI)为0.920(0.841~0.968),高于血清AACT与AAT单独预测[0.778(0.675~0.862),0.793(0.691~0.874)],差异有统计学意义(Z=2.456,2.466,均P <0.05)。结论 ARDS患者血清AACT与AAT水平均升高,二者均与患者30天生存预后密切相关,二者均对ARDS患者预后具有一定预测价值,且二者联合的预测价值更高。

Objective To investigate the expression and clinical significance of alpha-1-antichymotrypsin(AACT)and alpha-1-antitrypsin(AAT)in patients with acute respiratory distress syndrome(ARDS).Methods Eighty-four ARDS patients admitted to Sichuan Mianyang 404 Hospital from January 2019 to December 2022 were collected as the disease group,84 healthy individuals who underwent physical examinations in Sichuan Mianyang 404 Hospital were collected as the control group.enzyme linked immunosorbent assay(ELISA)was applied to detect the expression levels of serum AACT and AAT.Kaplan-Meier method was applied to analyze the relationship between serum AACT,AAT expression and prognosis in ARDS patients.COX regression analysis was applied to analyze the prognostic factors of ARDS patients.The predictive value of serum AACT and AAT expression on the prognosis of ARDS patients was analyzed using the receiver operating characteristic(ROC)curve.Results The expression levels of serum AACT(14.02±2.87ng/ml)and AAT(4.76±1.19g/L)in the disease group were higher than those in the reference group(9.56±2.11ng/ml,2.92±0.24g/L),and the differences were statistically significant(t=11.475,13.892,all P<0.05).The survival rates of the AACT and AAT high expression group in ARDS patients[40.00%(18/45),39.02%(16/41)]were lower than those of the AACT and AAT low expression group[84.62%(33/39),81.40%(35/43)]respectively,and the differences were statistically significant(χ^(2)=17.436,15.797,all P<0.001).Lower respiratory tract infections(HR=3.188,P=0.013),use of vasoactive substances(HR=2.656,P=0.045),immunosuppressive drugs(HR=6.118,P=0.001),duration from onset to treatment(HR=5.202,P=0.005).Acute physiological and chronic health evaluation II(APACHE II)(HR=5.368,P=0.003),serum AACT(HR=3.976,P=0.009)and AAT(HR=4.773,P=0.008)levels were all risk factors for 30 day mortality in ARDS patients,and the oxygenation index(OI)(HR=0.402,P=0.007)and invasive mechanical ventilation time(HR=0.461,P=0.013)were protective factors.The area under the ROC curve(AUC)(95%CI)of the combination of serum AACT and AAT in predicting poor prognosis in ARDS patients was 0.920(0.841~0.968),which was higher than those of individual predictions of serum AACT and AAT[0.778(0.675~0.862),0.793(0.691~0.874)],and the differences were statistically significant(Z=2.456,2.466,all P<0.05).Conclusion The serum AACT and AAT levels in ARDS patients were both elevated,and both were closely related to the 30 day survival prognosis of patients.Both have certain predictive value for the prognosis of ARDS patients,and the combined predictive value of the two is higher.