血清CC-16、MIP-1α与急性呼吸窘迫综合征病情的关系及其预后预测价值

Relationship and prognostic value of serum CC-16,MIP-1α and acute respiratory distress syndrome

目的 探讨血清Clara细胞分泌蛋白16(CC-16)、巨噬细胞炎症蛋白-1α(MIP-1α)与急性呼吸窘迫综合征(ARDS)病情的关系及其预后预测价值。方法 选取2021年9月—2023年9月哈励逊国际和平医院收治的168例ARDS患者,依据病情严重程度分为轻度组、中度组、重度组,同期70例健康志愿者作为对照组,采用酶联免疫吸附法检测受试者入院4 h内/体检当日血清CC-16、MIP-1α水平,Spearman相关性分析法评估CC-16、MIP-1α水平与ARDS患者病情的关系。依据28 d临床转归将168例ARDS患者分为死亡组、存活组,比较死亡组、存活组临床资料,多因素Logistic回归分析影响ARDS患者预后的危险因素,受试者工作特征(ROC)曲线评估血清CC-16,MIP-1α预测ARDS患者预后的效能。结果 ARDS患者血清CC-16、MIP-1α水平均高于对照组(P<0.05),且随着ARDS病情的加重,血清CC-16、MIP-1α水平呈上升趋势(P<0.05)。Spearman相关性分析结果显示,血清CC-16、MIP-1α水平与ARDS患者病情均呈正相关(r=0.534、0.578,P<0.05)。与存活组比较,死亡组年龄≥60岁患者比例、APACHEⅡ评分、SOFA评分及白细胞计数、C反应蛋白、白细胞介素-6、CC-16、MIP-1α水平均较高,氧合指数较低,组间差异均具有统计学意义(P<0.05)。年龄≥60岁(OR=1.702,95% CI:1.517~2.112)、APACHEⅡ评分(OR=1.769,95% CI:1.516~1.994)、氧合指数(OR=1.825,95% CI:1.622~2.368)、白细胞计数(OR=1.809,95% CI:1.624~2.257)、C反应蛋白(OR=1.808,95% CI:1.618~2.294)、白细胞介素-6(OR=1.805,95% CI:1.624~2.275)、CC-16(OR=1.819,95% CI:1.619~2.362)、MIP-1α(OR=1.821,95% CI:1.623~2.350)是影响ARDS患者预后的危险因素。ROC曲线结果显示,血清CC-16、MIP-1α联合预测ARDS患者预后的敏感度、曲线下面积(AUC)、约登指数分别为88.50%、0.908、0.533,均高于CC-16(83.60%、0.852、0.514)、MIP-1α(82.50%、0.864、0.520)的单独预测效能。结论 血清CC-16、MIP-1α在ARDS患者血清中高表达,且其表达水平与ARDS病情呈正相关,二者联合预测ARDS患者预后的效能较高。

ObjectiveTo investigate the relationship between serum Clara cell secreted protein 16(CC-16),macrophage inflammatory protein-1α(MIP-1α) and ARDS and its prognostic value.MethodsA total of 168 ARDS patients admitted to the hospital from September 2021 to September 2023 were divided into mild group,moderate group and severe group according to the severity of the condition,and 70 healthy volunteers were selected as the control group during the same period,serum CC-16 and MIP-1α levels within 4 h after admission/on the day of physical examination were detected by enzyme-linked immunosorbent assay,and the relationship between CC-16 and MIP-1α levels and the condition of ARDS patients was evaluated by Spearman correlation analysis.According to the 28-day clinical outcome,168 ARDS patients were divided into death group and survival group.,the clinical data of death group and survival group were compared,the risk factors affecting prognosis of ARDS patients were identified by Logistic multivariate regression analysis,and serum CC-16 was evaluated by ROC,efficacy of MIP-1α in predicting prognosis of ARDS patients.ResultsThe serum CC-16 and MIP-1α levels in ARDS patients were higher than those in control group(P<0.05),and the serum CC-16 and MIP-1α levels showed an increasing trend with the aggravation of ARDS disease(P<0.05).Spearman correlation analysis showed that serum CC-16 and MIP-1α levels were positively correlated with ARDS patients(r=0.534,0.578,P<0.05).Compared with the survival group,the proportion of age ≥60 years old,APACHE Ⅱ score,SOFA score,white blood cell count,C-reactive protein,interleukin-6,CC-16 and MIP-1α levels in the death group were higher,and the oxygenation index was lower,with statistical significance(P<0.05).Age ≥60years old(OR=1.702,95% CI:1.517-2.112),APACHE Ⅱ score(OR=1.769,95% CI:1.516-1.994),oxygenation index(OR=1.825,95% CI:1.622-2.368),white blood cell count(OR=1.809,95% CI:1.624-2.257),C-reactive protein(OR=1.808,95% CI:1.618-2.294),interleukin-6(OR=1.805,95% CI:1.624-2.275),CC-16(OR=1.819,95% CI:1.619-2.362),MIP-1α(OR=1.821,95% CI:1.623-2.350) were the risk factors affecting the prognosis of ARDS patients.ROC curve results showed that the sensitivity,AUC and Yoden index of serum CC-16 and MIP-1α combined to predict the prognosis of ARDS patients were 88.50%,0.908 and 0.533 respectively.,these results were higher than those of CC-16(83.60%,0.852,0.514) and MIP-1α(82.50%,0.864,0.520).ConclusionSerum CC-16 and MIP-1α are highly expressed in ARDS patients,and their expression levels are positively correlated with the disease of ARDS,and the combination of the two can predict the prognosis of ARDS patients.