血浆APN、sRAGE与ARDS患者预后的关系

doi:10.3969/j.issn.1673-8640.2021.11.001

摘要/Abstract

摘要：

目的探讨血浆脂联素（APN）、可溶性晚期糖基化终末产物受体（sRAGE）与急性呼吸窘迫综合征（ARDS）患者预后的关系。方法选取重症监护病房（ICU）ARDS患者120例,其中轻度患者21例（轻度组）、中度患者56例（中度组）、重度患者43例（重度组）。记录所有患者入院1 h的氧合指数、急性生理与慢性健康评分Ⅱ（APACHEⅡ）、序贯器官衰竭估计（SOFA）评分和肺损伤评分（LIS）,同时检测血浆APN和sRAGE水平。所有患者均随访12个月,计算死亡率。采用Logistic回归分析评估ARDS患者死亡的危险因素。结果轻度组、中度组和重度组血浆APN水平依次降低（P<0.05）,血浆sRAGE水平依次升高（P<0.05）。120例ARDS患者中死亡32例（26.67%）。死亡组氧合指数及血浆APN水平明显低于存活组（P<0.05）,APACHEⅡ评分、SOFA评分、LIS评分及血浆sRAGE水平明显高于存活组（P<0.05）。Logistic回归分析结果显示,APACHEⅡ评分、SOFA评分、APN、sRAGE是ARDS患者死亡的危险因素[比值比（OR）值分别为1.723、1.652、0.754和1.391,95%可信区间（CI）分别为1.206~2.461、1.110~2.459、0.624~0.912、1.117~1.732 ]。结论 APN、sRAGE与ARDS患者的病情严重程度及预后均有一定关系,或可作为判断ARDS严重程度和预后的指标之一。

关键词: 脂联素, 可溶性晚期糖基化终末产物受体, 急性呼吸窘迫综合征, 预后

Abstract:

Objective To investigate the relationship between plasma adiponectin（APN）,soluble receptor for advanced glycation end product（sRAGE） and the prognosis of patients with acute respiratory distress syndrome（ARDS）. Methods A total of 120 ARDS patients treated in intensive care unit（ICU） were enrolled,which included 21 mild patients（mild group）,56 moderate patients（moderate group） and 43 severe patients（severe group）. Oxygenation index,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score,sequential organ failure assessment（SOFA） score and lung injury score（LIS） at 1 h after admission were recorded,and the plasma levels of APN and sRAGE were determined. All the patients were followed up for 12 months to calculate the mortality. Logistic regression analysis was used to evaluate the risk factors of death in patients with ARDS. Results The levels of APN in mild group,moderate group and severe group decreased in turn（P<0.05）,and the levels of sRAGE in plasma increased in turn（P<0.05）. Among the 120 ARDS patients,32（26.67%） died. The oxygenation index and plasma APN level of death group were lower than those of survival group（P<0.05）,and the APACHE Ⅱ score,SOFA score,LIS and plasma sRAGE level of death group were higher than those of survival group（P<0.05）. APACHE Ⅱ score,SOFA score,APN and sRAGE were the risk factors of death in ARDS patients [odds ratio（OR） were 1.723,1.652,0.754 and 1.391,95% confidence intervals（CI） were 1.206-2.461,1.110-2.459,0.624-0.912 and 1.117-1.732,respectively]. Conclusions APN and sRAGE are related to the severity and prognosis of ARDS,which can be used as the indicators to evaluate the severity and prognosis of ARDS.

Key words: Adiponectin, Soluble receptor for advanced glycation end product, Acute respiratory distress syndrome, Prognosis

中图分类号:

R446.1

郭卫东, 付云, 高尚兰. 血浆APN、sRAGE与ARDS患者预后的关系[J]. 检验医学, 2021, 36(11): 1097-1100.

GUO Weidong, FU Yun, GAO Shanglan. Relationship between plasma APN,sRAGE and the prognosis of patients with ARDS[J]. Laboratory Medicine, 2021, 36(11): 1097-1100.

图/表 3

参考文献 21

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组别	例数	APN/（mg/L）	sRAGE/（ng/L）
轻度组	21	7.10±1.02	560.02±121.91
中度组	56	5.02±1.11^*	1 193.20±287.11^*
重度组	43	2.56±0.98^*#	2 011.20±320.10^*#
F值		32.022	50.021
P值		0.000	0.000

组别	例数	APN/（mg/L）	sRAGE/（ng/L）
轻度组	21	7.10±1.02	560.02±121.91
中度组	56	5.02±1.11^*	1 193.20±287.11^*
重度组	43	2.56±0.98^*#	2 011.20±320.10^*#
F值		32.022	50.021
P值		0.000	0.000

组别	例数	性别		年龄/岁	氧合指数/mmHg	APACHEⅡ/分
组别	例数	男/例	女/例	年龄/岁	氧合指数/mmHg	APACHEⅡ/分
死亡组	32	20	12	50.10±10.92	120.02±28.89	26.60±3.11
存活组	88	45	43	51.18±9.78	171.10±32.20	12.10±2.77
统计值		1.221		-0.518	-7.889	24.532
P值		0.269		0.605	0.000	0.000
组别	SOFA评分/分		LIS/分		APN/（mg/L）	sRAGE/（ng/L）
死亡组	10.10±2.17		1.90±0.40		3.40±1.00	1 988.91±298.19
存活组	6.82±1.18		1.32±0.28		6.11±1.15	1 078.29±210.00
统计值	10.561		8.892		-11.800	18.662
P值	0.000		0.000		0.000	0.000

组别	例数	性别		年龄/岁	氧合指数/mmHg	APACHEⅡ/分
组别	例数	男/例	女/例	年龄/岁	氧合指数/mmHg	APACHEⅡ/分
死亡组	32	20	12	50.10±10.92	120.02±28.89	26.60±3.11
存活组	88	45	43	51.18±9.78	171.10±32.20	12.10±2.77
统计值		1.221		-0.518	-7.889	24.532
P值		0.269		0.605	0.000	0.000
组别	SOFA评分/分		LIS/分		APN/（mg/L）	sRAGE/（ng/L）
死亡组	10.10±2.17		1.90±0.40		3.40±1.00	1 988.91±298.19
存活组	6.82±1.18		1.32±0.28		6.11±1.15	1 078.29±210.00
统计值	10.561		8.892		-11.800	18.662
P值	0.000		0.000		0.000	0.000

项目	β值	标准误	Wald值	P值	OR值（95%CI）
APACHEⅡ	0.544	0.182	8.934	0.000	1.723（1.206~2.461）
SOFA评分	0.502	0.203	6.115	0.000	1.652（1.110~2.459）
APN	-0.282	0.097	8.452	0.000	0.754（0.624~0.912）
sRAGE	0.330	0.112	8.681	0.000	1.391（1.117~1.732）
氧合指数	-0.182	0.192	0.899	0.722	0.834（0.572~1.214）
LIS	0.211	0.172	1.505	0.433	1.235（0.882~1.730）