Connelly K G, Moss M, Parsons P E, Moore E E, Moore F A, Giclas P C, Seligman P A, Repine J E
Webb-Waring Institute for Biomedical Research and Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA.
Am J Respir Crit Care Med. 1997 Jan;155(1):21-5. doi: 10.1164/ajrccm.155.1.9001283.
We investigated serum ferritin levels as a predictor of the acute respiratory distress syndrome (ARDS) because: (1) proinflammatory cytokines, which are implicated in ARDS, increase ferritin synthesis; and (2) oxidative stress in patients at risk for ARDS might liberate iron from ferritin, accelerating toxic hydroxyl radical (.OH) formation. Serum ferritin levels measured by radioimmunoassay (RIA) were greater in 75 patients at risk for ARDS (women, p < 0.0001; men, p < 0.0001) and 8 patients with ARDS (women, p = 0.001; men, p = 0.0009) than in healthy control subjects. Serum ferritin levels were also greater in female (p = 0.003) and male (p = 0.003) at-risk patients who developed ARDS than in patients who did not develop ARDS. In women, a value exceeding 270 ng/ml predicted ARDS with an 83% sensitivity, 71% specificity, 67% positive, and 86% negative predictive value. In men, a value exceeding 680 ng/ml predicted ARDS with a 60% sensitivity, 90% specificity, 75% positive, and 82% negative predictive value. Serum ferritin levels did not correlate with C-reactive protein levels, were not different in medical or surgical at-risk patients, and were not accounted for by liver disease. Evaluating serum ferritin levels in at-risk patients may help predict the development of ARDS and thereby improve study and treatment of ARDS. Elevated serum ferritin levels may also regulate the participation of iron in the oxidative responses that contribute to ARDS.
我们研究了血清铁蛋白水平作为急性呼吸窘迫综合征（ARDS）预测指标的情况，原因如下：（1）与ARDS相关的促炎细胞因子会增加铁蛋白的合成；（2）ARDS高危患者的氧化应激可能会使铁从铁蛋白中释放出来，加速有毒羟基自由基（·OH）的形成。通过放射免疫分析（RIA）测得的血清铁蛋白水平，在75例ARDS高危患者（女性，p<0.0001；男性，p<0.0001）和8例ARDS患者（女性，p = 0.001；男性，p = 0.0009）中高于健康对照者。发生ARDS的女性（p = 0.003）和男性（p = 0.003）高危患者的血清铁蛋白水平也高于未发生ARDS的患者。在女性中，超过270 ng/ml的值预测ARDS的敏感性为83%，特异性为71%，阳性预测值为67%，阴性预测值为86%。在男性中，超过680 ng/ml的值预测ARDS的敏感性为60%，特异性为90%，阳性预测值为75%，阴性预测值为82%。血清铁蛋白水平与C反应蛋白水平无关，在内科或外科高危患者中无差异，且不受肝脏疾病影响。评估高危患者的血清铁蛋白水平可能有助于预测ARDS的发生，从而改善ARDS的研究和治疗。血清铁蛋白水平升高也可能调节铁在导致ARDS的氧化反应中的参与情况。
