Gao Yang, Li Jun
NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Department of Intensive Care Unit, Chu Hsien-I Memorial Hospital of Tianjin Medical University, Tianjin Institute of Endocrinology, Tianjin 300134, China. Corresponding author: Gao Yang, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Jan;33(1):69-73. doi: 10.3760/cma.j.cn121430-20201021-00592.
To explore the clinical significance of the combined detection of Clara cell secretory protein 16 (CC16) and soluble receptor for advanced glycation end product (sRAGE) in the diagnosis and prognosis of acute respiratory distress syndrome (ARDS).
100 ARDS patients admitted to the intensive care unit (ICU) of Chu Hsien-I Memorial Hospital of Tianjin Medical University from July 2019 to September 2020 were enrolled as the ARDS group, and 100 non-ARDS patients admitted to the ICU during the same period were enrolled as the control group. The general information, vital signs, blood gas analysis, serum CC16 and sRAGE levels, duration of mechanical ventilation, length of ICU stay and prognosis during hospitalization were collected. The receiver operating characteristic (ROC) curve was drawn and the area under ROC curve (AUC) was calculated to evaluate the clinical value of CC16 and sRAGE lonely or combination in the diagnosis and prognosis of ARDS.
The duration of mechanical ventilation in the ARDS group was significantly longer than that in the non-ARDS group (days: 15.44±3.04 vs. 12.61±3.73, P < 0.01), and the hospitalization mortality was higher (38.0% vs. 9.0%, P < 0.01), but there was no significant difference in gender, age, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II) score or the length of ICU stay between the two groups. There were 62 ARDS patients survived and 38 ARDS patients died during hospitalization. The APACHE II score of the death group was significantly higher than that of the survival group (23.55±2.83 vs. 19.40±4.10, P < 0.01), but there was no significant difference in age, BMI, oxygenation index, mean arterial pressure, duration of mechanical ventilation or the length of ICU stay between the two groups. The serum levels of CC16 and sRAGE in the ARDS group were significantly higher than those in the non-ARDS group [CC16 (mg/L): 38.78±14.70 vs. 21.87±2.45, sRAGE (pg/L): 2 470.95±288.70 vs. 2 013.22±131.15, both P < 0.01]; and the serum levels of CC16 and sRAGE of ARDS patients in the death group were significantly higher than those in the survival group [CC16 (mg/L): 42.02±10.81 vs. 30.52±9.47, sRAGE (pg/L): 2 638.34±324.07 vs. 2 279.91±163.70, both P < 0.01]. ROC curve showed that the AUC of CC16 and sRAGE in the diagnosis of ARDS alone were 0.859 [95% confidence interval (95%CI) was 0.808-0.911] and 0.821 (95%CI was 0.762-0.879), and the best cut-off values were 25.76 mg/L and 2 203.00 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.932 (95%CI was 0.900-0.965) with the sensitivity of 89.0% and the specificity of 87.6%. The AUC of CC16 and sRAGE in predicting the death of patients with ARDS during hospitalization were 0.747 (95%CI was 0.651-0.843) and 0.819 (95%CI was 0.737-0.902), and the best cut-off values were 32.95 mg/L and 2 554.50 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.900 (95%CI was 0.828-0.972) with the sensitivity of 88.7% and the specificity of 84.5%.
Serum CC16 and sRAGE have clinical value for the diagnosis and prognosis of ARDS. The combined detection of them is superior to individual detection for early prediction of ARDS and prognosis.
探讨克拉拉细胞分泌蛋白16（CC16）与晚期糖基化终末产物可溶性受体（sRAGE）联合检测在急性呼吸窘迫综合征（ARDS）诊断及预后评估中的临床意义。
选取2019年7月至2020年9月在天津医科大学朱宪彝纪念医院重症监护病房（ICU）收治的100例ARDS患者作为ARDS组，同期收治的100例非ARDS患者作为对照组。收集两组患者的一般资料、生命体征、血气分析、血清CC16和sRAGE水平、机械通气时间、ICU住院时间及住院期间预后情况。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评估CC16和sRAGE单独及联合检测在ARDS诊断及预后评估中的临床价值。
ARDS组机械通气时间显著长于非ARDS组（天数：15.44±3.04 vs. 12.61±3.73，P<0.01），住院死亡率更高（38.0% vs. 9.0%，P<0.01），但两组在性别、年龄、体重指数（BMI）、急性生理与慢性健康状况评分系统II（APACHE II）评分或ICU住院时间方面差异无统计学意义。住院期间，ARDS组62例患者存活，38例患者死亡。死亡组APACHE II评分显著高于存活组（23.55±2.83 vs. 19.40±4.10，P<0.01），但两组在年龄、BMI、氧合指数、平均动脉压、机械通气时间或ICU住院时间方面差异无统计学意义。ARDS组血清CC16和sRAGE水平显著高于非ARDS组[CC16（mg/L）：38.78±14.70 vs. 21.87±2.45，sRAGE（pg/L）：2470.95±288.70 vs. 2013.22±131.15，均P<0.01]；ARDS死亡组患者血清CC16和sRAGE水平显著高于存活组[CC16（mg/L）：42.02±10.81 vs. 30.52±9.47，sRAGE（pg/L）：2638.34±324.07 vs. 2279.91±163.70，均P<0.01]。ROC曲线显示，CC16和sRAGE单独诊断ARDS的AUC分别为0.859[95%置信区间（95%CI）为0.808 - 0.911]和0.821（95%CI为0.762 - 0.879），最佳截断值分别为25.76 mg/L和2203.00 pg/L；CC16和sRAGE联合检测的AUC为0.932（95%CI为0.900 - 0.965），灵敏度为89.0%，特异度为87.6%。CC16和sRAGE预测ARDS患者住院期间死亡的AUC分别为0.747（95%CI为0.651 - 0.843）和0.819（95%CI为0.737 - 0.902），最佳截断值分别为32.95 mg/L和2554.50 pg/L；CC16和sRAGE联合检测的AUC为0.900（95%CI为0.828 - 0.972），灵敏度为88.7%，特异度为84.5%。
血清CC16和sRAGE对ARDS的诊断及预后评估具有临床价值。二者联合检测在ARDS早期诊断及预后评估方面优于单独检测。
