血浆可溶性晚期糖基化终产物受体水平在危重患者呼吸机相关性肺炎预后中的意义
Evaluation of plasma soluble receptors for advanced glycation end-products on the prognosis of critically ill patients with ventilator-associated pneumonia

唐瑾.血浆可溶性晚期糖基化终产物受体水平在危重患者呼吸机相关性肺炎预后中的意义[J].内科急危重症杂志,2021,27(2):121-124

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DOI：10.11768/nkjwzzzz20210208

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基金项目:吉市科计字\[2018\]6号(49)

作者	单位	E-mail
唐瑾	上海市东方医院吉安医院	wxuebin@163.com

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中文摘要:

目的：观察晚期糖基化终产物（RAGE）及其代谢产物可溶性晚期糖基化终末产物受体(sRAGE)水平对危重患者呼吸机相关性肺炎（VAP）预后的预测作用。方法：回顾性分析40例VAP患者的临床资料，根据患者28 d生存状况分为存活组（24例）和死亡组（16例）。采用实时荧光定量RT-PCR检测患者外周血单个核细胞（PMBC）中RAGE mRNA表达。采用酶联免疫吸附法检测患者血浆sRAGE和血清炎症因子白介素-6（IL-6）、白介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）水平。采用受试者工作特征曲线(ROC)分析相关指标与VAP患者死亡的关系。结果：28 d病死率为40%（16/40）。与存活组比较，死亡组患者PMBC中RAGE mRNA及PCT、IL-6、TNF-α和sRAGE水平显著升高（ P ＜0.01或 P ＜0.05）。血浆中sRAGE水平ROC曲线下面积为0.779，最佳截点为2.59 ng/L，敏感度、特异度分别为81.3%、73.9%（ P ＝0.003）。PMBC中RAGE mRNA的ROC曲线下面积为0.749，IL-6为0.872，TNF-α为 0.720，PCT为0.879，CRP为0.310。结论：血浆sRAGE水平及PMBC中RAGE mRNA的升高与VAP患者的死亡密切相关。血浆sRAGE水平对预测VAP患者的预后具有一定的意义。

英文摘要:

Objective: To observe the predictive effect of receptors for advanced glycation end products (RAGE) and their metabolites soluble receptors for advanced glycation end products (sRAGE) on critically ill patients with ventilator-associated pneumonia (VAP). Methods: The retrospective analysis was done on 40 cases of VAP. All the patients according to the 28-day survival were divided into two groups: survival group (24 cases) and death group (16 cases). The RAGE mRNA expression in human peripheral blood mononuclear cells (PMBC) was detected by real-time-PCR. ELISA method was used to detect the protein expression of sRAGE, IL-6, IL-8 and TNF-alpha in the plasma and serum of patients. Correlation between these indicators and mortality in VAP patients was analyzed by ROC curve. Results: The 28-day mortality in VAP patients was 40% (16/40). As compared with survival group, the RAGE mRNA, PCT, IL-6, TNF-α and sRAGE levels in death group were significantly increased ( P <0.01 or P <0.05). The area under the ROC curve of the plasma sRAGE level was 0.779, and the best cut-off point was 2.59 ng/L. The sensitivity and specificity of the assay were 81.3% and 73.9% respectively ( P =0.003). Under the other ROC curves, the area of PMBC RAGE mRNA, IL-6, TNF-α, PCT and CRP was 0.749, 0.872, 0.720, 0.879, and 0.310 respectively. Conclusions: The elevation of plasma sRAGE and PMBC RAGE mRNA is closely related to the death of VAP. The level of sRAGE in plasma has a certain significance in predicting the prognosis of VAP patients.