Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070, Brussels, Belgium.
Intensive Care Med. 2015 Feb;41(2):231-8. doi: 10.1007/s00134-014-3589-9. Epub 2014 Dec 16.
Endothelial cell activation and dysfunction are involved in the pathophysiology of ARDS. Circulating endothelial cells (CECs) may be a useful marker of endothelial dysfunction and damage but have been poorly studied in ARDS. We hypothesized that the CEC count may be elevated in patients with sepsis-related ARDS compared to those with sepsis without ARDS.
ARDS was defined according to the Berlin consensus definition. The study population included 17 patients with moderate or severe ARDS, 9 with mild ARDS, 13 with sepsis and no ARDS, 13 non-septic patients, and 12 healthy volunteers. Demographic, hemodynamic, and prognostic variables, including PaO(2)/FiO(2) ratio, 28-day survival, blood lactate, APACHE II, and SOFA score, were recorded. CECs were counted in arterial blood samples using the reference CD146 antibody-based immunomagnetic isolation and UEA1-FITC staining method. Measurements were performed 12-24 h after diagnosis of ARDS and repeated daily for 3 days.
The median day-1 CEC count was significantly higher in patients with moderate or severe ARDS than in mild ARDS or septic-control patients [27.2 (18.3-49.4) vs. 17.4 (11-24.5) cells/ml (p < 0.034), and 18.4 (9.1-31) cells/ml (p < 0.035), respectively]. All septic patients (with or without ARDS) had higher day-1 CEC counts than the non-septic patients [19.6 (14.2-30.6) vs. 10.8 (5.7-13.2) cells/ml, p = 0.002].
The day-1 CEC count was significantly higher in ARDS patients than in other critically ill patients, and in moderate or severe ARDS patients compared to those with milder disease, making it a potentially useful marker of ARDS severity.
内皮细胞的激活和功能障碍与 ARDS 的病理生理学有关。循环内皮细胞（CEC）可能是内皮功能障碍和损伤的有用标志物，但在 ARDS 中研究甚少。我们假设，与没有 ARDS 的败血症患者相比，败血症相关 ARDS 患者的 CEC 计数可能升高。
ARDS 根据柏林共识定义进行定义。研究人群包括 17 例中重度 ARDS 患者、9 例轻度 ARDS 患者、13 例败血症且无 ARDS 患者、13 例非败血症患者和 12 例健康志愿者。记录人口统计学、血流动力学和预后变量，包括 PaO(2)/FiO(2) 比值、28 天生存率、血乳酸、APACHE II 和 SOFA 评分。使用参考 CD146 抗体免疫磁分离和 UEA1-FITC 染色法在动脉血样中计数 CEC。在 ARDS 诊断后 12-24 小时进行测量，并在接下来的 3 天内每天重复测量。
中重度 ARDS 患者的第 1 天 CEC 计数中位数明显高于轻度 ARDS 或败血症对照组患者[27.2（18.3-49.4）比 17.4（11-24.5）细胞/ml（p<0.034）和 18.4（9.1-31）细胞/ml（p<0.035）]。所有败血症患者（有或没有 ARDS）的第 1 天 CEC 计数均高于非败血症患者[19.6（14.2-30.6）比 10.8（5.7-13.2）细胞/ml，p=0.002]。
第 1 天的 CEC 计数在 ARDS 患者中明显高于其他危重病患者，在中重度 ARDS 患者中明显高于轻度疾病患者，使其成为 ARDS 严重程度的一个潜在有用标志物。
