Rubin D B, Wiener-Kronish J P, Murray J F, Green D R, Turner J, Luce J M, Montgomery A B, Marks J D, Matthay M A
Department of Medicine, University of California Medical Center, San Francisco General Hospital Medical Center 94143.
J Clin Invest. 1990 Aug;86(2):474-80. doi: 10.1172/JCI114733.
In this prospective study of 45 patients, we tested the hypothesis that markedly elevated levels of plasma von Willebrand antigen (vWf-Ag) a marker of endothelial cell injury, might predict the development of acute lung injury in patients with nonpulmonary sepsis syndrome. Acute lung injury was quantified on a four-point scoring system. At the time of entry into the study, none of the 45 patients had evidence of lung injury. Subsequently, 15 patients developed lung injury and 30 patients did not develop lung injury. The mean plasma vWf-Ag level was markedly elevated in the 15 patients who developed lung injury compared with the 30 patients who did not develop lung injury (588 +/- 204 vs. 338 +/- 196, percentage of control, P less than 0.01). Furthermore, a plasma vWf-Ag level greater than or equal to 450 was 87% sensitive and 77% specific for predicting the development of acute lung injury in the setting of nonpulmonary sepsis. In addition, the combination of a plasma vWf-Ag greater than 450 and nonpulmonary organ failure at the time of entry into the study had a positive predictive value of 80% for acute lung injury. Also, a plasma vWf-Ag level greater than 450 had a positive predictive value of 80% for identifying nonsurvivors. Thus, in patients with nonpulmonary sepsis, an elevated level of plasma vWf-Ag is a useful, early biochemical marker of endothelial injury and it has both predictive and prognostic value.
在这项针对45例患者的前瞻性研究中，我们检验了这样一个假设：血浆血管性血友病因子抗原（vWf-Ag）水平显著升高作为内皮细胞损伤的标志物，可能预测非肺部脓毒症综合征患者急性肺损伤的发生。急性肺损伤采用四分制评分系统进行量化。在进入研究时，45例患者均无肺损伤证据。随后，15例患者发生肺损伤，30例患者未发生肺损伤。发生肺损伤的15例患者的平均血浆vWf-Ag水平显著高于未发生肺损伤的30例患者（588±204对338±196，对照百分比，P<0.01）。此外，血浆vWf-Ag水平大于或等于450对于预测非肺部脓毒症情况下急性肺损伤的发生具有87%的敏感性和77%的特异性。另外，在进入研究时血浆vWf-Ag大于450与非肺部器官衰竭相结合，对急性肺损伤的阳性预测值为80%。而且，血浆vWf-Ag水平大于450对于识别非幸存者的阳性预测值为80%。因此，在非肺部脓毒症患者中，血浆vWf-Ag水平升高是内皮损伤的一种有用的早期生化标志物，具有预测和预后价值。
