Chen Cheng-Yu, Yang Kuang-Yao, Chen Mei-Yu, Chen Hsuan-Yu, Lin Ming-Tzer, Lee Yu-Chin, Perng Reury-Perng, Hsieh Shie-Liang, Yang Pan-Chyr, Chou Teh-Ying
Institute of Clinical Medicine, National Yang-Ming University, Taipei.
Am J Respir Crit Care Med. 2009 Oct 15;180(8):751-60. doi: 10.1164/rccm.200902-0222OC. Epub 2009 Jul 30.
Acute respiratory distress syndrome (ARDS), a serious inflammatory reaction to acute lung injury, is associated with high mortality rates. Decoy receptor (DcR) 3 is a soluble protein with immunomodulatory effects. Biomarkers that reliably predict outcomes in ARDS are not currently available.
Comparing DcR3 with the Acute Physiology and Chronic Health Evaluation (APACHE) II scores and three other plasma markers to explore the association of DcR3 and the clinical outcome in ARDS.
Eighty-eight patients with ARDS were studied. Baseline APACHE II scores and clinical data were recorded. Plasma levels of DcR3, soluble triggering receptor expressed on myeloid cells (sTREM)-1, tumor necrosis factor (TNF)-alpha, and IL-6 were measured on Day 1 and later time points, and correlated with the survival status on Day 28 after the onset of ARDS. For validation, 59 patients with ARDS from another medical center were studied.
Among the biomarkers evaluated, only DcR3 discriminated the survivors and nonsurvivors at all time points in the first week of ARDS. DcR3 independently associated with and best predicted the 28-day mortality of patients with ARDS. Plasma DcR3 levels most correlated to multiple-organ dysfunction and ventilator dependence. Compared with survivors, the nonsurvivors had higher DcR3 levels regardless of the APACHE II scores. Kaplan-Meier survival analysis showed higher mortality in patients with ARDS with higher DcR3 levels. The outcome prediction of patients with ARDS by plasma DcR3 levels was recapitulated by the validation cohort.
High plasma DcR3 levels correlate with development of multiple-organ dysfunction and independently predict the 28-day mortality in patients with ARDS.
急性呼吸窘迫综合征（ARDS）是对急性肺损伤的一种严重炎症反应，死亡率很高。诱饵受体（DcR）3是一种具有免疫调节作用的可溶性蛋白。目前尚无可靠预测ARDS预后的生物标志物。
比较DcR3与急性生理与慢性健康状况评分系统（APACHE）Ⅱ评分以及其他三种血浆标志物，以探讨DcR3与ARDS临床预后的相关性。
对88例ARDS患者进行研究。记录基线APACHEⅡ评分和临床数据。在第1天及之后的时间点测量血浆中DcR3、髓系细胞表面可溶性触发受体（sTREM）-1、肿瘤坏死因子（TNF）-α和白细胞介素（IL）-6的水平，并将其与ARDS发病后第28天的生存状况相关联。为进行验证，对来自另一个医疗中心的59例ARDS患者进行了研究。
在所评估的生物标志物中，只有DcR3在ARDS第一周的所有时间点都能区分存活者和非存活者。DcR3与ARDS患者的28天死亡率独立相关且预测效果最佳。血浆DcR3水平与多器官功能障碍和呼吸机依赖最为相关。与存活者相比，无论APACHEⅡ评分如何，非存活者的DcR3水平更高。Kaplan-Meier生存分析显示，DcR3水平较高的ARDS患者死亡率更高。验证队列重现了血浆DcR3水平对ARDS患者预后的预测结果。
血浆DcR3水平升高与多器官功能障碍的发生相关，并独立预测ARDS患者的28天死亡率。
