血清HIF-1α、VEGF水平与急性呼吸窘迫综合征临床预后的关系

Relationships between serum HIF-1α and VEGF levels and clinical prognosis of acute respiratory deistress syndrome

目的探讨血清低氧诱导因子1α(HIF-1α)和血管内皮生长因子(VEGF)水平与急性呼吸窘迫综合征(ARDS)患者预后的关系及临床意义。方法采用前瞻性对照研究,选择本院2016年8月至2017年12收治的ARDS患者98例为研究对象,选择本院同期体检健康者30例作为对照组。根据ARDS患者治疗后30 d随访结局将患者分为死亡组(48例)和存活组(50例)。记录受试者入院24 h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、氧合指数(PaO2/FiO2)、肺损伤评分(LIS),检测两组受试者血清HIF-1α、VEGF水平,采用Logistic回归分析影响ARDS患者预后的危险因素,ROC曲线分析血清HIF-1α、VEGF对ARDS患者不良预后的预测价值。结果 ARDS组患者血清HIF-1α、VEGF水平、APACHEⅡ、SOFA、LIS评分分别为(99.27±18.04)ng/L、(134.52±24.46)ng/L、(19.88±5.14)分、(7.81±1.42)分、(1.68±0.72)分,显著高于对照组的(46.18±8.39)ng/L、(41.96±7.59)ng/L、(14.26±4.73)分、(3.48±0.63)分、(0.28±0.05)分,差异均有统计学意义(P<0.05);ARDS组患者PaO2/FiO2水平为(164.37±27.39)mm Hg,显著低于对照组的(394.36±65.68)mm Hg,差异有统计学意义(P<0.05)。死亡组ARDS患者血清HIF-1α、VEGF水平、APACHEⅡ、SOFA、LIS评分显著高于存活组,差异均有统计学意义(P<0.05);PaO2/FiO2水平显著低于存活组,差异有统计学意义(P<0.05)。Logistic分析显示,血清HIF-1α水平、VEGF水平、APACHEⅡ评分、LIS评分、PaO2/FiO2是影响ARDS患者预后的危险因素(P<0.05);血清HIF-1α、VEGF水平预测ARDS患者不良预后的曲线下面积分别为0.943、0.914(P<0.05)。结论 ARDS患者血清HIF-1α和VEGF水平升高,检测血清HIF-1α和VEGF水平对监测ARDS患者疾病进程和预后判断具有一定参考价值。

Objective To detect the levels of serum hypoxia inducible factor-1α(HIF-1α)and vascular endothelial growth factor(VEGF),and explore their relationships with the prognosis of patients with acute respiratory distress syndrome(ARDS)and clinical significances.Methods A prospective control study was conducted.98 patients with ARDS admitted to our hospital from August 2016 to December 2017 were selected as the study subjects,and 30 healthy persons in our hospital during the same period were selected as the control group.The patients were divided into death group(48 cases)and survival group(50 cases)according to the 30-day follow-up results of ARDS patients after treatment.The sequential organ failure assessment(SOFA)score,Oxygenation index(PaO2/FiO2)and lung injury score(LIS)were recorded within24 h of admission.Serum HIF-1αand VEGF levels were measured.Logistic regression was used to analyze the risk factors affecting the prognosis of ARDS patients.ROC curve analysis of serum HIF-1α,VEGF levels was used to predict adverse prognosis of ARDS patients.Results The serum HIF-1α,VEGF levels,and APACHE II,SOFA,LIS scores in ARDS group[(99.27±18.04)ng/L,(134.52±24.46)ng/L,(19.88±5.14),(7.81±1.42)and(1.68±0.72),respectively]were significantly higher than those in control group[(46.18±8.39)ng/L,(41.96±7.59)ng/L,(14.26±4.73),(3.48±0.63)and(0.28±0.05)](P<0.05),and the level of PaO2/FiO2 was significantly lower than that in control group[(164.37±27.39)mm Hg vs.(394.36±65.68)mm Hg,P<0.05];the serum HIF-1α,VEGF levels,and APACHE II,SOFA,LIS scores in the death group were significantly higher than those in the survival group(P<0.05),and the level of PaO2/FiO2 was significantly lower than that in the survival group(P<0.05).Logistic analysis showed that serum HIF-1α,VEGF levels,and APACHE II,LIS scores and PaO2/FiO2 were risk factors affecting the prognosis of ARDS patients(P<0.05);the area under the curve of serum HIF-1αand VEGF levels in predicting adverse prognosis of ARDS patients was 0.943 and 0.914,respectively(P<0.05).Conclusions Serum HIF-1αand VEGF levels in patients with ARDS were increased.The detection of serum HIF-1αand VEGF levels has certain reference value for monitoring the disease progression and judging prognosis of ARDS patients.