血浆半乳糖凝集素-3对急性呼吸窘迫综合征严重程度及临床结局的预测价值

The Predictive Value of Plasma Galectin-3 for Ards Severity and Clinical Outcome.

作者信息

Xu Zhiheng, Li Xi, Huang Yongbo, Mao Pu, Wu Sulong, Yang Baoxin, Yang Yuanyuan, Chen Kangxie, Liu Xiaoqing, Li Yimin

机构信息

*State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, Guangzhou, China †Department of Infection Control, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

出版信息

Shock. 2017 Mar;47(3):331-336. doi: 10.1097/SHK.0000000000000757.

DOI:10.1097/SHK.0000000000000757

PMID:27648691

Abstract

BACKGROUND

Galectin-3 is a β-galactoside-binding lectin implicated as a mediator in a variety of inflammatory and fibrotic diseases. However, information about galectin-3 release in patients with acute respiratory distress syndrome (ARDS) is very limited. We sought to determine whether plasma galectin-3 levels were increased in ARDS patients and were associated with disease severity.

METHODS

Patients admitted to intensive care unit (ICU) within 48 h and diagnosed with ARDS were identified. In addition, healthy subjects were assigned to a control group. Plasma samples were collected from patients within 48 h after ICU admission as well as healthy subjects. Plasma galectin-3 levels were measured by enzyme-linked immunosorbent assay. The primary outcome was mortality at 28 days.

RESULTS

Sixty-three ARDS patients were identified. Among these, 27 patients died within 28 days of admission. The plasma galectin-3 levels of the patients were significantly higher than those of control subjects (median [IQR]: 12.37 [7.94-18.79] vs. 5.01 [4.15-5.69] ng/mL, respectively, P <0.0001). Furthermore, galectin-3 levels were significantly higher in non-surviving patients than in those who survived (15.38 [11.59-22.98] vs. 10.07 [7.39-15.54] ng/mL, respectively, P = 0.0136). Plasma galectin-3 levels were significantly correlated with acute physiology and chronic health evaluation II scores and arterial oxygen tension/inspiratory oxygen fraction ratios (Spearman rho = 0.44, P <0.0001 and -0.616, P <0.0001, respectively). At an optimal cutoff of 10.59 ng/mL, the sensitivity and specificity of galectin-3 for prediction of 28-day mortality were 81.48% (95% CI 0.62-0.94) and 55.56% (95% CI 0.38-0.72), respectively.

CONCLUSIONS

Higher levels of galectin-3 were significantly associated with disease severity and worse outcomes in ARDS patients.

摘要

背景

半乳糖凝集素-3是一种β-半乳糖苷结合凝集素，被认为是多种炎症和纤维化疾病的介质。然而，关于急性呼吸窘迫综合征（ARDS）患者中半乳糖凝集素-3释放的信息非常有限。我们试图确定ARDS患者血浆半乳糖凝集素-3水平是否升高以及是否与疾病严重程度相关。

方法

确定在48小时内入住重症监护病房（ICU）并被诊断为ARDS的患者。此外，将健康受试者分配到对照组。在ICU入院后48小时内从患者以及健康受试者中采集血浆样本。通过酶联免疫吸附测定法测量血浆半乳糖凝集素-3水平。主要结局是28天死亡率。

结果

确定了63例ARDS患者。其中，27例患者在入院28天内死亡。患者的血浆半乳糖凝集素-3水平显著高于对照组（中位数[四分位间距]：分别为12.37[7.94 - 18.79]与5.01[4.15 - 5.69]ng/mL，P<0.0001）。此外，未存活患者的半乳糖凝集素-3水平显著高于存活患者（分别为15.38[11.59 - 22.98]与10.07[7.39 - 15.54]ng/mL，P = 0.0136）。血浆半乳糖凝集素-3水平与急性生理与慢性健康状况评分系统II评分以及动脉血氧分压/吸入氧分数比值显著相关（斯皮尔曼相关系数分别为0.44，P<0.0001和 - 0.616，P<0.0001）。在最佳临界值为10.59 ng/mL时，半乳糖凝集素-3预测28天死亡率的敏感性和特异性分别为81.48%（95%CI 0.62 - 0.94）和55.56%（95%CI 0.38 - 0.72）。