中性粒细胞胞外诱捕网、ANGPTL4及MIP-1α与急性呼吸窘迫综合征严重程度相关性及对临床转归的预测价值

Correlation between neutrophil extracellular traps,ANGPTL4 and MIP-1αand severity of acute respiratory distress syndrome and their predictive value of clinical outcomes

目的分析中性粒细胞胞外诱捕网(NET)、血管生成素样蛋白4(ANGPTL4)及巨噬细胞炎性蛋白1α(MIP-1α)与急性呼吸窘迫综合征(ARDS)严重程度相关性及对临床转归的预测价值。方法回顾性将2021年1月至2023年1月延安市人民医院治疗的102例ARDS患者纳入观察组,其中重度ARDS患者42例,非重度ARDS患者60例;另选102名健康体检者纳入对照组。检测所有入选者血清NET的标志物游离DNA(cf-DNA/NET)、ANGPTL4、MIP-1α水平;分析cf-DNA/NET、ANGPTL4、MIP-1α与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、氧合指数的关系;采用受试者操作特征(ROC)曲线分析cf-DNA/NET、ANGPTL4、MIP-1α对ARDS患者病死的预测效能。结果观察组血清cf-DNA/NET、ANGPTL4、MIP-1α水平分别为(480.25±114.73)ng/mL、(1065.93±225.85)ng/mL、(125.98±36.81)pg/mL,均高于对照组[(136.82±24.57)ng/mL、(205.82±44.71)ng/mL、(52.43±12.74)pg/mL],差异均有统计学意义(P<0.05)。重度ARDS患者血清cf-DNA/NET、ANGPTL4、MIP-1α水平分别为(541.64±130.05)ng/mL、(1358.19±289.80)ng/mL、(156.34±51.79)pg/mL,均高于非重度ARDS患者[(405.82±62.37)ng/mL、(863.92±187.43)ng/mL、(89.72±25.04)pg/mL],差异均有统计学意义(P<0.05)。经Pearson相关性分析,ARDS患者血清cf-DNA/NET、ANGPTL4、MIP-1α水平均与APACHEⅡ评分呈正相关(P<0.05),与氧合指数呈负相关(P<0.05)。经多因素Logistic回归分析,ARDS患者血清cf-DNA/NET、ANGPTL4、MIP-1α均是其病死的独立预测因素(P<0.05)。经ROC曲线分析,血清cf-DNA/NET、ANGPTL4联合MIP-1α预测ARDS患者病死的AUC为0.928。结论血清cf-DNA/NET、ANGPTL4及MIP-1α均在ARDS患者外周血中呈高表达,均与其病情严重程度有关,联合应用可提高对患者病死的预测效能。

Objective To analyze the correlation between neutrophil extracellular trap net(NET),sample angiogenin protein 4(ANGPTL4)and macrophage inflammatory protein 1 alpha(MIP-1α)and severity of acute respiratory distress syndrome(ARDS)and their predictive value of clinical outcomes.Methods A total of 102 ARDS patients treated in Yan'an People's Hospital from January 2021 to January 2023 were retrospectively included in the observation group,including 42 patients with severe ARDS and 60 patients with non-severe ARDS;another 102 healthy subjects were included in the control group.The serum marker free DNA(cf-DNA/NET),ANGPTL4,MIP-1αlevels,and the correlation between cf-DNA/ANGPTL4-NET,ANGPTL4,MIP-1α,acute physiology and chronic health status evaluationⅡ(APACHEⅡ)score,oxygenation index were analyzed.The predictive efficacy of cf-DNA/NET,ANGPTL4,and MIP-1αon mortality in ARDS patients was analyzed using receiver operating characteristic(ROC)curves.Results The levels of serum cf-DNA/NET,ANGPTL4,and MIP-1αin the observation group were(480.25±114.73)ng/mL,(1065.93±225.85)ng/mL,and(125.98±36.81)pg/mL,respectively,higher than those in the control group[(136.82±24.57)ng/mL,(205.82±44.71)ng/mL,and(52.43±12.74)pg/mL],and the differences were statistically significant(P<0.05).The levels of serum cf-DNA/NET,ANGPTL4,and MIP-1αin severe ARDS patients were(541.64±130.05)ng/mL,(1358.19±289.80)ng/mL,(156.34±51.79)pg/mL,which were higher than those in non-severe ARDS patients[(405.82±62.37)ng/mL,(863.92±187.43)ng/mL,(89.72±25.04)pg/mL],and the differences were statistically significant(P<0.05).After the Pearson correlation analysis,levels of serum cf-DNA/NET,ANGPTL4,and MIP-1αin ARDS patients were all positively correlated with the APACHEⅡscore(P<0.05),negative correlation with oxygenation index(P<0.05).After a multivariate Logistic regression analysis,serum cf-DNA/NET,ANGPTL4,and MIP-1αwere all independent predictors of mortality(P<0.05).After the ROC curve analysis,serum cf-DNA/NET,ANGPTL4 combined with MIP-1αpredicted an AUC of 0.928.Conclusion Serum cf-DNA/NET,ANGPTL4 and MIP-1α,peripheral blood in patients with ARDS has high expression are related to its illness severity,joint application can improve the prediction of patients die.