Yang Q, Li Z Q, Lan H B, Xiong S S, Wang S S, Yan C S
Department of Respiratory Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China.
Zhonghua Yi Xue Za Zhi. 2017 Jul 11;97(26):2023-2027. doi: 10.3760/cma.j.issn.0376-2491.2017.26.002.
To explore the biomarkers that applied to pulmonary acute respiratory distress syndrome (ARDS) and extrapulmonary ARDS respectively. A total of 49 eligible patients with ARDS were selected from Department of Respiratory intensive care unite (ICU) , Department of General ICU and Department of Emergency ICU, the Second Affiliated Hospital of Nanchang University, during April 2015 and February 2016, and divided into pulmonary ARDS group (=26) and extrapulmonary ARDS group (=23) according to primary causes. Totally 19 cases from healthy examination personnel were served as control. Acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ) score and lung injury score of all hospitalized patients were completed within 24 hours after the diagnosis of ARDS and the serum levels of angiogenin2 (Ang-2) , surfactant protein D (SP-D), soluble receptor for advanced glycation end products (sRAGE), Krebs von den Lungen-6 (KL-6) were measured. Then the 28-day outcomes were observed. The serum levels of the biomarkers were compared between each group and correlation analysis was conducted between different indexes. Finally, The relationship between the four biomarkers and the outcome of each group was analyzed. The serum level of Ang-2 in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[1 462 (569, 3 638) and 4 568 (2 236, 8 457) vs 460 (389, 578) ng/L, all <0.05], and the serum level of Ang-2 was significantly higher in extrapulmonary ARDS group than that in pulmonary ARDS group (<0.05). The serum level of SP-D in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[5.9 (2.5, 22.7) mg/L and 3.7 (1.7, 6.5) vs 1.9 (0.6, 4.4) mg/L, all <0.05], and the serum level of SP-D was significantly higher in pulmonary ARDS group than that in extrapulmonary ARDS group (<0.05). The serum level of sRAGE in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[238 (101, 583) and 229 (114, 443) vs 117 (88, 176) ng/L, all <0.05]. The serum level of KL-6 in pulmonary ARDS group was significantly higher than that in control group[10 435 (3 401, 17 607) vs 4 780 (3 962, 5 320) U/L, <0.05]. Increased serum levels of SP-D (=1.089, 95% 1.001-1.085) and KL-6 (=1.206, 95% 1.016-1.432) at the early stage were the independent prognostic factors for the 28-day mortality for pulmonary ARDS. Advanced age (=2.622, 95% 1.046-6.574) was the independent prognostic factor for the 28-day mortality for extrapulmonary ARDS. SP-D and KL-6 may be the serum biomarkers of pulmonary ARDS and Ang-2 may be the serum biomarker of extrapulmonary ARDS.
为探索分别适用于肺源性急性呼吸窘迫综合征（ARDS）和肺外源性ARDS的生物标志物。2015年4月至2016年2月期间，从南昌大学第二附属医院呼吸重症监护病房（ICU）、综合ICU及急诊ICU选取49例符合条件的ARDS患者，根据原发病因分为肺源性ARDS组（n = 26）和肺外源性ARDS组（n = 23）。选取19例健康体检者作为对照。所有住院患者在ARDS诊断后24小时内完成急性生理与慢性健康状况评分Ⅲ（APACHEⅢ）及肺损伤评分，并检测血清血管生成素2（Ang-2）、表面活性蛋白D（SP-D）、晚期糖基化终产物可溶性受体（sRAGE）、克雷伯斯费尔德-6（KL-6）水平。随后观察28天结局。比较各组生物标志物血清水平，并对不同指标进行相关性分析。最后，分析4种生物标志物与各组结局的关系。肺源性ARDS组和肺外源性ARDS组的Ang-2血清水平均显著高于对照组[1462（569，3638）和4568（2236，8457） vs 460（389，578）ng/L，均P<0.05]，且肺外源性ARDS组的Ang-2血清水平显著高于肺源性ARDS组（P<0.05）。肺源性ARDS组和肺外源性ARDS组的SP-D血清水平均显著高于对照组[5.9（2.5，22.7）mg/L和3.7（1.7，6.5） vs 1.9（0.6，4.4）mg/L，均P<0.05]，且肺源性ARDS组的SP-D血清水平显著高于肺外源性ARDS组（P<0.05）。肺源性ARDS组和肺外源性ARDS组的sRAGE血清水平均显著高于对照组[238（101，583）和229（114，443） vs 117（88，176）ng/L，均P<0.05]。肺源性ARDS组的KL-6血清水平显著高于对照组[10435（3401，17607） vs 4780（3962，5320）U/L，P<0.05]。早期SP-D（β = 1.089，95%CI 1.001 - 1.085）和KL-6（β = 1.206，95%CI 1.016 - 1.432）血清水平升高是肺源性ARDS患者28天死亡率的独立预后因素。高龄（β = 2.622，95%CI 1.046 - 6.574）是肺外源性ARDS患者28天死亡率的独立预后因素。SP-D和KL-6可能是肺源性ARDS的血清生物标志物，而Ang-2可能是肺外源性ARDS的血清生物标志物。
