Peng Min, Yan Qing-He, Gao Ying, Zhang Zhen, Zhang Ying, Wang Yi-Feng, Wu He-Ning
Department of Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin 300070, China.
World J Clin Cases. 2021 Nov 16;9(32):9731-9740. doi: 10.12998/wjcc.v9.i32.9731.
Acute respiratory distress syndrome (ARDS) is injury of alveolar epithelial cells and capillary endothelial cells caused by various factors, including endogenous and exogenous lung factors, leading to diffuse pulmonary interstitial and alveolar edema, and acute respiratory failure. ARDS involves alveolar epithelial cells and pulmonary interstitial capillary endothelial cells. Circulating endothelial cells (CECs) are the only marker that directly reflects vascular endothelial injury There have been few studies on the correlation between peripheral blood CECs and ARDS at home and abroad. The lungs are the organs with the highest capillary density and the most endothelial cells, thus, it is speculated that when ARDS occurs, CECs are stimulated and damaged, and released into the circulatory system.
To explore the correlation between CEC level and severity of ARDS in patients postoperatively.
Blood samples were collected from all patients on day 2 (d2) and day 5 (d5) after surgery. The control group comprised 32 healthy volunteers. Number of CECs was measured by flow cytometry, and operation time was recorded. Changes in various indexes of patients were monitored, and diagnosis of ARDS was determined based on ARDS Berlin definition. We comprised d2 CECs in different groups, correlation between operation time and d2 CECs, ARDS of different severity by d2 CECs, and predictive value of d2 CECs for ARDS in postoperative patients.
The number of d2 CECs in the ARDS group was significantly higher than that in the healthy control group ( < 0.001). The number of d2 CECs in the ARDS group was significantly higher than that in the non-ARDS group ( < 0.001). The number of d2 CECs in the non-ARDS group was significantly higher than that in the healthy control group ( < 0.001). Operation time was positively correlated with number of CECs on d2 (rs = 0.302, = 0.001). The number of d2 CECs in the deceased group was significantly higher than that in the improved group ( < 0.001). There was no significant difference in number of d2 CECs between patients with mild and moderate ARDS. The number of d2 CECs in patients with severe ARDS was significantly higher than that in patients with mild and moderate ARDS ( = 0.041, = 0.037). There was no significant difference in number of d5 and d2 CECs in the non-ARDS group after admission to intensive care. The number of d5 CECs was higher than the number of d2 CECs in the ARDS improved group ( < 0.001). The number of d5 CECs was higher than the number of d2 CECs in the ARDS deceased group ( = 0.002). If the number of CECs was > 1351/mL, sensitivity and specificity of predicting ARDS were 80.8% and 78.1%, respectively.
Changes in number of CECs might predict occurrence and adverse outcome of ARDS after surgery, and higher numbers of CECs indicate worse prognosis of ARDS.
急性呼吸窘迫综合征（ARDS）是由多种因素引起的肺泡上皮细胞和毛细血管内皮细胞损伤，这些因素包括内源性和外源性肺因素，可导致弥漫性肺间质和肺泡水肿以及急性呼吸衰竭。ARDS涉及肺泡上皮细胞和肺间质毛细血管内皮细胞。循环内皮细胞（CECs）是直接反映血管内皮损伤的唯一标志物。国内外关于外周血CECs与ARDS之间相关性的研究较少。肺是毛细血管密度最高且内皮细胞最多的器官，因此，推测当ARDS发生时，CECs受到刺激和损伤，并释放到循环系统中。
探讨术后患者CEC水平与ARDS严重程度之间的相关性。
在术后第2天（d2）和第5天（d5）采集所有患者的血样。对照组包括32名健康志愿者。通过流式细胞术测量CECs数量，并记录手术时间。监测患者各项指标的变化，并根据ARDS柏林定义确定ARDS的诊断。我们比较了不同组的d2 CECs、手术时间与d2 CECs之间的相关性、d2 CECs对不同严重程度ARDS的影响以及d2 CECs对术后患者ARDS的预测价值。
ARDS组d2 CECs数量显著高于健康对照组（<0.001）。ARDS组d2 CECs数量显著高于非ARDS组（<0.001）。非ARDS组d2 CECs数量显著高于健康对照组（<0.001）。手术时间与d2时的CECs数量呈正相关（rs = 0.302，= 0.001）。死亡组d2 CECs数量显著高于好转组（<0.001）。轻度和中度ARDS患者之间的d2 CECs数量无显著差异。重度ARDS患者的d2 CECs数量显著高于轻度和中度ARDS患者（= 0.041，= 0.037）。重症监护病房收治后，非ARDS组d5和d2 CECs数量无显著差异。ARDS好转组d5 CECs数量高于d2 CECs数量（<0.001）。ARDS死亡组d5 CECs数量高于d2 CECs数量（= 0.002）。如果CECs数量>1351/mL，预测ARDS的敏感性和特异性分别为80.8%和78.1%。
CECs数量的变化可能预测术后ARDS的发生和不良结局，CECs数量越高表明ARDS的预后越差。
