脓毒症相关ARDS患者BMP9表达及其在疾病早期识别及预后预测中的作用

Expression of bone morphogenetic protein 9 in patients with sepsis-associated acute respiratory distress syndrome and its role in early recognition and prognosis prediction of disease

目的观察脓毒症相关急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者骨形态发生蛋白9(bone morphogenetic protein 9,BMP9)表达水平,探讨BMP9在脓毒症相关ARDS早期识别及预后预测中的作用。方法选取山西白求恩医院2022年5月至2023年5月收治的脓毒症相关ARDS患者56例作为ARDS组,心源性肺水肿患者49例作为病例对照组,同期于本院体检中心进行健康体检的成人46名作为健康对照组。追踪随访ARDS组患者28 d的转归情况,分为存活组26例和死亡组30例。分析比较各组受试者血清BMP9表达水平及其与临床指标的相关性,采用Logistic回归分析脓毒症相关ARDS发病的危险因素,并对相关指标进行诊断效能及预后预测价值分析。结果脓毒症相关ARDS组患者血清BMP9水平[1401.14(856.59,1982.86)pg/mL]高于病例对照组(438.26±128.52)pg/mL及健康对照组(398.96±96.55)pg/mL,差异有统计学意义(P<0.01)。而且BMP9表达与炎症指标降钙素原、淋巴细胞计数及疾病严重程度序贯器官衰竭评分(sequential organ failure assessment,SOFA)均显著相关(P<0.05,P<0.01)。采用多因素Logistic回归分析显示,BMP9是脓毒症相关ARDS发病的高危因素(P<0.01)。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),BMP9预测脓毒症相关ARDS发生的ROC曲线下面积(area under the ROC curve,AUC)为0.930,特异度为100.0%,敏感度为80.4%,明显高于氧合指数的特异度(89.8%)和敏感度(67.9%)。追踪随访并比较脓毒症相关ARDS不同预后患者BMP9水平,发现相较于存活组,死亡组患者BMP9表达水平更高,差异有统计学意义(P<0.05)。绘制ROC曲线,分析BMP9在脓毒症相关ARDS患者预后预测中的作用,ROC曲线下面积为0.699,敏感度为43.3%,特异度为100.0%。结论脓毒症相关ARDS患者BMP9表达明显升高,而且其高表达与炎症指标降钙素原、淋巴细胞计数及疾病严重SOFA评分呈显著相关性。BMP9是脓毒症相关ARDS患者发病的独立危险因素,有希望作为早期识别脓毒症相关ARDS的新型生物标志物,但其对疾病预后并没有显示很好的预测作用。

Objective To observe the expression level of bone morphogenetic protein 9(bone morphogenetic protein 9,BMP9)in patients with sepsis-associated acute respiratory distress syndrome(acute respiratory distress syndrome,ARDS),and to explore the role of BMP9 in early recognition and prognosis prediction of sepsis-associated ARDS.Methods From May 2022 to May 2023,total of 56 patients with sepsis-associated ARDS in Shanxi Bethune Hospital were selected as the ARDS group,49 patients with cardiogenic pulmonary edema as the case control group,and 46 adults who underwent physical examination in the physical examination center of our hospital as the healthy control group.The patients in the ARDS group were followed up for 28 days and divided into survival group(n=26)and death group(n=30).The expression level of serum BMP9 and its correlation with clinical indicators in each group were analyzed and compared.The risk factors of sepsis-associated ARDS were analyzed by Logistic regression,and the diagnostic efficacy and prognostic value of related indicators were analyzed.Results The serum level of BMP9 in sepsis-associated ARDS group[1401.14(856.59,1982.86)]pg/mL was significantly higher than that in case control group(438.26±128.52)pg/mL and healthy control group(398.96±96.55)pg/mL,the differences were statistically significant(P<0.01).In addition,BMP9 expression significantly correlated with procalcitonin,lymphocyte count and SOFA score(P<0.05,P<0.01,respectively).Multivariate Logistic regression analysis showed that BMP9 was a high risk factor for the development of sepsis-associated ARDS(P<0.01).The area under the ROC curve(area under the ROC curve,AUC)of BMP9 to predict the occurrence of sepsis-associated ARDS was 0.930.The specificity was 100.0%and the sensitivity was 80.4%,which was significantly higher than the specificity(89.8%)and sensitivity(67.9%)of the oxygenation index.Follow-up and comparison of BMP9 levels in patients with different prognosis of sepsis-associated ARDS showed that the expression level of BMP9 in the death group was higher than that in the survival group,and the difference was statistically significant(P<0.05).The ROC curve of BMP9 in predicting the prognosis of patients with sepsis-associated ARDS.The area under the ROC curve was 0.699,the sensitivity was 43.3%,and the specificity was 100.0%.Conclusions The expression of BMP9 in sepsis-associated ARDS patients significantly increased,and its high expression was significantly correlated with inflammatory markers such as procalcitonin,lymphocyte count and SOFA score.BMP9 is an independent risk factor in patients with sepsis-associated ARDS,and it is promising as a new biomarker for early identification of sepsis-associated ARDS.However,it do not show a good predictive effect on the prognosis of the disease.