可溶性基质裂解素2及急性生理与慢性健康状况评分Ⅱ可评估老年急性呼吸窘迫综合征患者的预后

李娟.可溶性基质裂解素2及急性生理与慢性健康状况评分Ⅱ可评估老年急性呼吸窘迫综合征患者的预后[J].内科急危重症杂志,2021,27(3):213-216

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DOI：10.11768/nkjwzzzz20210309

中文关键词: 急性呼吸窘迫综合征可溶性基质裂解素2 急性生理与慢性健康状况评估肺损伤预后

英文关键词:

基金项目:山东省中医药科技发展计划项目（No：2017-187）

作者	单位	E-mail
李娟	山东省泰山医院重症医学科	liu36552888@163.com

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中文摘要:

目的：探讨血清可溶性基质裂解素2（sST2）及急性生理与慢性健康状况评估（APACHE Ⅱ）评分对老年急性呼吸窘迫综合征（ARDS）患者肺损伤程度及预后的评估价值。方法：选取2018年1月-2019年10月在山东省泰山医院接受治疗的106例ARDS患者，根据患者病情严重程度分为重度组（36例）、中度组（38例）和轻度组（32例），根据患者28d后的预后分为存活组（62例）、死亡组（44例）。比较各组患者的临床资料、氧合指数（PaO2/FiO2）、C反应蛋白（CRP）、降钙素原（PCT）、血清sST2水平及APACHEⅡ评分，进行Pearson相关性分析，采用受试者工作特征曲线（ROC）分析血清sST2水平及APACHE Ⅱ评分对老年ARDS患者预后的评估价值。结果：重度组患者的血清sST2水平、APACHEⅡ评分等指标明显高于中度组和轻度组，且中度组高于轻度组（P均＜0.05）。死亡组患者的血清sST2水平、APACHE Ⅱ评分等指标高于存活组（P均＜0.05）。Pearson分析显示，ARDS患者血清sST2水平与CRP、PCT水平、肺损伤评分、APACHE Ⅱ评分呈正相关，与PaO2/FiO2呈负相关（P均＜0.05）；ARDS患者的APACHE Ⅱ评分与年龄、CRP、PCT、肺损伤评分、sST2呈正相关，与PaO2/FiO2呈负相关（P均＜0.05）。ROC曲线分析显示，血清sST2水平及APACHE Ⅱ评分对老年ARDS患者预后有一定的评估价值，曲线下面积分别为0.749、0.796。联合应用后评估价值可得到进一步提升，其敏感度、特异性、约登指数分别为0.886、0.677、0.563。结论：血清sST2水平及APACHE Ⅱ评分对老年ARDS患者肺损伤程度及预后有较高的评估价值。

英文摘要:

Objective:To investigate the predictive value of serum soluble suppression of tumorigenicity 2 (sST2) and acute physiology and chronic health evaluation II (APACHE II) score on the degree of lung injury and prognosis in elderly patients with acute respiratory distress syndrome (ARDS). Methods:A total of 106 patients with ARDS who were treated in Taishan Hospital, Shandong Province from January 2018 to October 2019 were selected, and they were divided into severe group (36 cases), moderate group (38 cases) and mild group (32 cases) according to the severity of the disease. In addition, they were divided into survival group (62 cases) and death group (44 cases) according to the prognosis of patients after 28 days. The clinical data, oxygenation index (PaO2/FiO2), C-reactive protein (CRP), procalcitonin (PCT), sST2 and APACHE II score in each group were analyzed. Pearson was used for correlation analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum sST2 and APACHE II score for the prognosis of elderly patients with ARDS. Results:The sST2, APACHE II score and other indicators in severe group were significantly higher than those in moderate group and mild group (all P< 0.05), and the above indexes in moderate group were significantly higher than those in the mild group (all P< 0.05). The sST2, APACHE II score and other indicators in the death group were significantly higher than those in the survival group (all P< 0.05). Pearson analysis showed that serum sST2 was positively correlated with CRP, PCT, lung injury score and APACHE II score, and negatively with PaO2/FiO2 (P< 0.05). The APACHE II score in patients with ARDS was positively correlated with age, CRP, PCT, lung injury score and sST2, and negatively correlated with PaO2/FiO2 (P< 0.05). The ROC curve analysis showed that serum sST2 and APACHE II score had a high predictive value for the prognosis of elderly patients with ARDS, and the areas under the curve were 0.749 and 0.796, respectively. After combined application, the predictive value could be further improved, the sensitivity, specificity and Youden index were 0.886, 0.677 and 0.563, respectively. Conclusion:Serum sST2 and APACHE II score have a high predictive value for the lung injury and prognosis of elderly patients with ARDS.