血清IGF-1、MCP-1及ET-1在食管癌术后急性呼吸窘迫综合征中的表达及临床意义

Expression and clinical significance of serum IGF⁃1,MCP⁃1 and ET⁃1 in acute respiratory distress syndrome after esophageal cancer surgery

目的 分析胰岛素样生长因子1(IGF-1)、单核细胞趋化蛋白-1(MCP-1)及内皮素-1(ET-1在食管癌术后急性呼吸窘迫综合征(ARDS)中的表达及临床意义。方法 选取2020年12月至2022年5月于河南省人民医院行食管癌手术患者256例,依据术后是否发生ARDS分为非ARDS组194例、ARDS组62例。比较非ARDS组、ARDS组的血清IGF-1、MCP-1、ET-1水平。比较ARDS组术后不同时间点血清IGF-1、MCP-1、ET-1水平。比较ARDS组不同病情程度血清IGF-1、MCP-1、ET-1水平及APACHEⅡ评分。采用Pearson分析血清IGF-1、MCP-1、ET-1水平与APACHEⅡ评分的相关性,绘制ROC曲线分析IGF-1、MCP-1、ET-1单独或联合检测对食管癌ARDS术后的预测价值。结果 ARDS组血清IGF-1、MCP-1、ET-1水平均明显高于非ARDS组,差异具有统计学意义(P<0.05)。血清IGF-1、MCP-1、ET-1水平比较:术后7 d>术后4 d>术后1 d,差异具有统计学意义(P<0.05)。血清IGF-1、MCP-1、ET-1水平及APACHEⅡ评分比较:重度组>中度组>轻度组,差异具有统计学意义(P<0.05)。血清IGF-1、MCP-1、ET-1水平与APACHEⅡ评分呈正相关(P<0.05)。IGF-1、MCP-1、ET-1联合检测对食管癌食管癌术后ARDS的灵敏度、特异度、AUC(95%CI)分别为93.27%、90.05%、0.811(0.774~0.932);均高于上述指标单一检测(P<0.05)。结论 血清IGF-1、MCP-1、ET-1在食管癌术后ARDS中表达升高,且与ARDS病情发展相关,有望成为评判食管癌术后ARDS发生及病情程度的标志物,且三者联合检测对食管癌术后ARDS的预测价值更高。

Objective To analyze the expression and clinical significance of insulin-like growth factor 1(IGF-1),monocyte chemoattractant protein-1(MCP-1)and endothelin-1(ET-1)in patients with acute respiratory distress syndrome(ARDS)after esophageal cancer surgery.Methods From December 2020 to May 2022,256 patients with esophageal cancer were selected and divided into two groups:the non-ARDS group(194 cases)and the ARDS group(62 cases)based on the occurrence of ARDS after the operation.The levels of serum IGF-1,MCP-1 and ET-1 were compared between the non-ARDS and ARDS groups.The lev-els of serum IGF-1,MCP-1 and ET-1 were compared at different time points after the operation within the AR-DS group.Furthermore,the levels of serum IGF-1,MCP-1,ET-1 and APACHEⅡscore were compared with the ARDS group.Pearson correlation analysis was used to examine the relationship between serum IGF-1,MCP-1,ET-1 levels and APACHEⅡscore.Moreover,the ROC curves were drawn to analyze the predictive value of IGF-1,MCP-1 and ET-1 detection alone or in combination after ARDS for esophageal cancer.Results Serum levels of IGF-1,MCP-1 and ET-1 in the ARDS group were significantly higher than those in the non-ARDS group,and the difference was statistically significant(P<0.05).The comparison of serum IGF-1,MCP-1 and ET-1 levels showed that 7 days after surgery>4 days>1 day after surgery,with a statistically sig-nificant difference(P<0.05).The comparison of serum IGF-1,MCP-1,ET-1 levels,and APACHEⅡscores indicated that the severe group>moderate group>mild group,with a statistically significant difference(P<0.05).Serum levels of IGF-1,MCP-1 and ET-1 were positively correlated with APACHEⅡscores(P<0.05).The sensitivity,specificity,and AUC(95%CI)of the combined detection of IGF-1,MCP-1 and ET-1 for ARDS after esophageal cancer surgery were 93.27%,90.05%and 0.811(0.774~0.932)respectively.All these values were higher than the above indicators(P<0.05).Conclusion The levels of serum IGF-1,MCP-1 and ET-1 are elevated in patients with ARDS following esophageal cancer surgery.This increase is associated with the development of ARDS and could serve as a marker for evaluating both the occurrence and severity of AR-DS post-surgery.Additionally,the combined measurement of all three markers may be more valuable in pre-dicting the likelihood of ARDS after esophageal cancer surgery.