MMP-9对急性呼吸窘迫综合征并脓毒性休克患者的早期诊断及预后评估价值研究

A study on the value of MMP-9 in early diagnosis and prognostic evaluation of patients with acute respiratory distress syndrome complicated with septic shock

目的探讨基质金属蛋白酶-9(MMP-9)对急性呼吸窘迫综合征(ARDS)并脓毒性休克患者早期诊断和预后评估的价值。方法选取2020年4月至2023年4月广西壮族自治区人民医院收治的113例ARDS患者为研究对象,根据患者确诊后24 h内休克发生情况将其分为ARDS并脓毒性休克组(61例)和ARDS非脓毒性休克组(52例)。选取同期22名健康志愿者作为正常对照组。根据患者治疗后28 d转归情况,将ARDS并脓毒性休克组患者分为存活组(27例)和死亡组(34例)。比较各组一般资料以及MMP-9表达水平。采用受试者工作特征(ROC)曲线评估MMP-9对ARDS并脓毒性休克患者早期诊断的准确性。采用logistic回归分析探讨ARDS并脓毒性休克患者预后的影响因素。结果ARDS并脓毒性休克组、ARDS非脓毒性休克组的MMP-9表达水平均高于正常对照组,ARDS非脓毒性休克组的MMP-9表达水平高于ARDS并脓毒性休克组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,MMP-9可有效预测ARDS并脓毒性休克的发生[AUC(95%CI)=0.666(0.565~0.767)],其最佳临界值为28.53 ng/mL,对应的灵敏度为47.50%,特异度为94.20%。多因素logistic回归分析结果显示,MMP-9[OR(95%CI)=0.976(0.954~0.999)]、氧合指数[OR(95%CI)=0.978(0.957~1.000)]、IL-6[OR(95%CI)=1.004(1.000~1.008)]是ARDS并脓毒性休克患者死亡的影响因素(P<0.05)。ROC曲线分析结果显示,MMP-9可有效预测ARDS并脓毒性休克患者的预后[AUC(95%CI)=0.735(0.605~0.865)],其最佳临界值为33.83 ng/mL,对应的灵敏度为70.59%,特异度为77.78%。结论MMP-9对ARDS并脓毒性休克有较好的早期诊断价值,对ARDS并脓毒性休克患者的病情严重程度及预后有一定的预测作用。

Objective To explore the value of matrix metalloproteinase-9(MMP-9)in early diagnosis and prognostic evaluation of patients with acute respiratory distress syndrome(ARDS)complicated with septic shock.Methods A total of 113 ARDS patients admitted to the People′s Hospital of Guangxi Zhuang Autonomous Region from April 2020 to April 2023 were selected as the study subjects.The patients were divided into ARDS complicated with septic shock group(61 cases)and ARDS non-septic shock group(52 cases)according to the occurrence of shock within 24 hours after they were diagnosed with ARDS.A total of 22 healthy volunteers were selected as the normal control group during the same period.The patients in the ARDS complicated with septic shock group were divided into survival group(27 cases)and death group(34 cases)according to their outcomes 28 days after treatment.The general data and the level of MMP-9 expression in each group were compared.Receiver operating characteristic(ROC)curve was used to evaluate the accuracy of MMP-9 in the early diagnosis of ARDS complicated with septic shock patients.Logistic regression analysis was used to explore the influencing factors of prognosis of the ARDS complicated with septic shock patients.Results The level of MMP-9 expression in the ARDS complicated with septic shock group and the ARDS non-septic shock group was higher than that in the normal control group,and the level of MMP-9 expression in the ARDS non-septic shock group was higher than that in the ARDS complicated with septic shock group,and the differences were statistically significant(P<0.05).The results of ROC curve analysis showed that MMP-9 could effectively predict the occurrence of ARDS complicated with septic shock[AUC(95%CI)=0.666(0.565-0.767)],and the optimal cut-off value was 28.53 ng/mL,and the corresponding sensitivity and specificity were 47.50%and 94.20%,respectively.The results of multivariate logistic regression analysis showed that MMP-9[OR(95%CI)=0.976(0.954-0.999)],oxygenation index[OR(95%CI)=0.978(0.957-1.000)]and interleukin-6(IL-6)[OR(95%CI)=1.004(1.000-1.008)]were influencing factors for death in the ARDS complicated with septic shock patients(P<0.05).The results of ROC curve analysis showed that MMP-9 could effectively predict the prognosis of the ARDS complicated with septic shock patients[AUC(95%CI)=0.735(0.605-0.865)],and the optimal cut-off value was 33.83 ng/mL,and the corresponding sensitivity and specificity were 70.59%and 77.78%,respectively.Conclusion MMP-9 has good value in early diagnosis of ARDS complicated with septic shock,and has a certain predictive effect on the severity and prognosis of ARDS complicated with septic shock patients.