Huang Chong-Min, Li Juan-Juan, Wei Wei-Ke
Department of Intensive Medicine, The Second People's Hospital of Haining City, Haining 314419, Zhejiang Province, China.
Department of Integrated Traditional Chinese and Western Medicine, Qingyang Hospital, Hangzhou 310023, Zhejiang Province, China.
World J Clin Cases. 2024 Feb 16;12(5):966-972. doi: 10.12998/wjcc.v12.i5.966.
The diagnosis of sepsis combined with acute respiratory distress syndrome (ARDS) has increased owing to the enhanced awareness among medical professionals and the continuous development of modern medical technologies, while early diagnosis of ARDS still lacks specific biomarkers. One of the main pathogenic mechanisms of sepsis-associated ARDS involves the actions of various pathological injuries and inflammatory factors, such as platelet and white blood cells activation, leading to an increase of surface adhesion molecules. These adhesion molecules further form platelet-white blood cell aggregates, including platelet-mononuclear cell aggregates (PMAs). PMAs has been identified as one of the markers of platelet activation, here we hypothesize that PMAs might play a potential biomarker for the early diagnosis of this complication.
To investigate the expression of PMAs in the serum of patients with sepsis complicated by ARDS and its clinical significance.
We selected 72 hospitalized patients diagnosed with sepsis as the study population between March 2019 and March 2022. Among them, 30 patients with sepsis and ARDS formed the study group, while 42 sepsis patients without ARDS comprised the control group. After diagnosis, venous blood samples were immediately collected from all patients. Flow cytometry was employed to analyze the expression of PMAs, platelet neutrophil aggregates (PNAs), and platelet aggregates (PLyAs) in the serum. Additionally, the Acute Physiology and Chronic Health Evaluation (APACHE) II score was calculated for each patient, and receiver operating characteristic curves were generated to assess diagnostic value.
The study found that the levels of PNAs and PLyAs in the serum of the study group were higher than those in the control group, but the difference was not statistically significant ( > 0.05). However, the expression of PMAs in the serum of the study group was significantly upregulated ( < 0.05) and positively correlated with the APACHE II score ( = 0.671, < 0.05). When using PMAs as a diagnostic indicator, the area under the curve value was 0.957, indicating a high diagnostic value ( < 0.05). Furthermore, the optimal cutoff value was 8.418%, with a diagnostic sensitivity of 0.819 and specificity of 0.947.
In summary, the serum levels of PMAs significantly increase in patients with sepsis and ARDS. Therefore, serum PMAs have the potential to become a new biomarker for clinically diagnosing sepsis complicated by ARDS.
由于医学专业人员认识的提高和现代医疗技术的不断发展，脓毒症合并急性呼吸窘迫综合征（ARDS）的诊断有所增加，而ARDS的早期诊断仍缺乏特异性生物标志物。脓毒症相关ARDS的主要发病机制之一涉及各种病理损伤和炎症因子的作用，如血小板和白细胞活化，导致表面黏附分子增加。这些黏附分子进一步形成血小板-白细胞聚集体，包括血小板-单核细胞聚集体（PMA）。PMA已被确定为血小板活化的标志物之一，在此我们假设PMA可能是这种并发症早期诊断的潜在生物标志物。
探讨脓毒症合并ARDS患者血清中PMA的表达及其临床意义。
选取2019年3月至2022年3月期间住院诊断为脓毒症的72例患者作为研究对象。其中，30例脓毒症合并ARDS患者组成研究组，42例无ARDS的脓毒症患者组成对照组。诊断后，立即采集所有患者的静脉血样本。采用流式细胞术分析血清中PMA、血小板-中性粒细胞聚集体（PNA）和血小板聚集体（PLyA）的表达。此外，计算每位患者的急性生理与慢性健康状况评分系统（APACHE）Ⅱ评分，并绘制受试者工作特征曲线以评估诊断价值。
研究发现，研究组血清中PNA和PLyA水平高于对照组，但差异无统计学意义（>0.05）。然而，研究组血清中PMA的表达显著上调（<0.05），且与APACHEⅡ评分呈正相关（=0.671，<0.05）。以PMA作为诊断指标时，曲线下面积值为0.957，表明诊断价值较高（<0.05）。此外，最佳截断值为8.418%，诊断敏感性为0.819，特异性为0.947。
综上所述，脓毒症合并ARDS患者血清中PMA水平显著升高。因此，血清PMA有可能成为临床诊断脓毒症合并ARDS的新生物标志物。
