摘要
目的探讨血清骨髓相关蛋白8和14(myeloid-related proteins 8 and 14,Mrp 8/14)在肺源性和肺外源性脓毒症致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中的差异及其在预后中的预测价值。方法采用回顾性队列研究的方法,收集2021年8月至2024年2月在南京医科大学附属南京医院重症监护室(intensive care unit,ICU)住院的脓毒症ARDS患者的一般临床资料,检测入院24 h内血清Mrp 8/14的水平。根据ICU住院期间患者是否死亡,将肺源性及肺外源性脓毒症ARDS患者分别分为存活组与死亡组,比较两组患者血清Mrp 8/14水平及一般临床资料的差异。采用Logistic回归分析探讨影响肺源性及肺外源性脓毒症ARDS患者的预后因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评估Mrp 8/14水平对肺源性和肺外源性脓毒症ARDS患者预后的预测价值。结果本研究共纳入138例脓毒症ARDS患者,其中79例为肺源性,59例为肺外源性。与死亡组相比,肺源性脓毒症ARDS存活组患者Mrp 8/14水平较低[Mrp 8/14:22.90(17.91,30.88)μg/mL vs.10.73(7.15,17.20)μg/mL,P<0.05]。多因素Logistic回归分析发现,Mrp 8/14(OR=1.253,95%CI:1.110~1.414,P<0.05)仅是ICU肺源性脓毒症ARDS患者死亡的独立危险因素。ROC曲线分析显示,Mrp 8/14预测ICU肺源性脓毒症ARDS患者死亡的曲线下面积为0.855(95%CI:0.773~0.938,P<0.05),以19.230μg/mL为最佳截断值,对应的敏感度为0.718,特异度为0.925,约登指数为0.405。结论血清Mrp 8/14对肺源性脓毒症ARDS患者的预后具有一定的预测价值。
Objective To investigate the differences and prognostic value of serum myeloidrelated proteins 8 and 14(Mrp 8/14)in patients with acute respiratory distress syndrome(ARDS)induced by pulmonary and extrapulmonary sepsis.Methods A retrospective cohort study was conducted to collect the general clinical data of septic ARDS patients admitted to the intensive care unit(ICU)of Nanjing Hospital of Nanjing Medical University from August 2021 to February 2024.The serum levels of Mrp 8/14 were detected within 24 hours after admission.According to whether the patients died during ICU stay,the patients with pulmonary ARDS and extrapulmonary ARDS induced by sepsis were divided into survival and death groups,respectively.The differences of Mrp 8/14 and other clinical data between the two groups were compared.Logistic regression analysis was used to analyze the prognostic factors of septic patients with pulmonary ARDS and extrapulmonary ARDS.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of serum Mrp 8/14 for the prognosis of patients with pulmonary ARDS and extrapulmonary ARDS.Results A total of 138 patients with sepsis-induced ARDS were enrolled in this study,including 79 patients with pulmonary ARDS and 59 patients with extrapulmonary ARDS.Compared to the death group,the level of serum Mrp 8/14 was significantly lower[Mrp 8/14:22.90(17.91,30.88)μg/mL vs.10.73(7.15,17.20)μg/mL,P<0.05].Multivariate logistic regression analysis demonstrated that the serum Mrp 8/14 level was an independent risk factor for the prognosis of pulmonary ARDS patients only during the ICU stay(OR=1.253,95%CI:1.110-1.414,P<0.05).ROC curve analysis showed that the area under the curve of serum Mrp 8/14 for the prediction of death in ARDS patients with pulmonary sepsis during ICU stay was 0.855(95%CI:0.773-0.938,P<0.05),the cut-off value was 19.230μg/mL,the sensitivity was 0.718,the specificity was 0.925,and the Yonden index was 0.405.Conclusion Serum Mrp 8/14 is an effective prognostic indicator for the mortality of ARDS patients with pulmonary sepsis during ICU hospitalization.
作者
孙才智
谢永鹏
朱晨晨
秦海东
李小民
Sun Caizhi;Xie Yongpeng;Zhu Chenchen;Qin Haidong;Li Xiaomin(Department of Emergency Medicine,Lianyungang Clinical College of Nanjing Medical University,The First People’s Hospital of Lianyungang City,Lianyungang 222002,China;Department of Emergency Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《中华急诊医学杂志》
北大核心
2025年第1期78-83,共6页
Chinese Journal of Emergency Medicine
基金
江苏省科技厅社会发展面上项目(BE2020670)
南京市医学科技发展计划项目(YKK22115)。
