摘要
目的探讨成纤维细胞生长因子21(FGF⁃21)、巨噬细胞炎性蛋白1α(MIP⁃1α)及活化素A(Activin⁃A)对急性呼吸窘迫综合征(ARDS)患者病情评估及预后预测的临床价值。方法选取2019年1月至2022年1月江苏省如皋市人民医院呼吸重症病房110例ARDS患者作为研究对象,根据病情严重程度将ARDS患者分为轻度组(n=44)、中度组(n=32)、重度组(n=34)。检测三组血清FGF⁃21、MIP⁃1α及Activin⁃A表达水平。采用Pearson相关分析评估血清FGF⁃21、MIP⁃1α和Activin⁃A水平与APACHEⅡ评分的相关性。根据患者28 d生存结局将生存患者记为生存组(n=78),随访期间死亡患者记为死亡组(n=32),采用Logistic回归分析ARDS患者死亡的危险因素,采用受试者工作特征(ROC)曲线分析上述指标对ARDS患者预后的预测价值。结果不同病情严重程度患者血清FGF⁃21水平:轻度组>中度组>重度组,MIP⁃1α和Activin⁃A水平:重度组>中度组>轻度组,差异有统计学意义(均P<0.05)。预后分析显示,生存组78例,死亡组32例。死亡组FGF⁃21水平低于生存组,MIP⁃1α、Activin⁃A水平高于生存组,差异有统计学意义(P<0.05)。相关性分析表明,ARDS患者血浆FGF⁃21与APACHEⅡ评分呈负相关(r=0.569),MIP⁃1α(r=0.498)及Activin⁃A(r=0.633)与APACHEⅡ评分呈正相关(P<0.05)。多因素Logistic回归分析显示,低水平FGF⁃21、高水平MIP⁃1α和高水平Activin⁃A均是ARDS患者死亡的独立危险因素(均P<0.05)。ROC曲线分析显示,FGF⁃21、MIP⁃1α和Activin⁃A预测ARDS死亡的灵敏度分别为0.738、0.761、0.699,特异度分别为0.805、0.752、0.774,AUC值分别为0.787、0.833、0.778;三项指标联合检测的灵敏度为0.806,特异度为0.832,AUC值为0.899(P<0.05)。结论FGF⁃21、MIP⁃1α和Activin⁃A水平与ARDS患者病情严重程度和预后相关,对患者预后具有预测价值,可为临床诊治提供参考。
Objective To investigate the clinical value of FGF⁃21,MIP⁃1αand Activin⁃A in the assessment and prognosis of ARDS patients.Methods A total of 110 ARDS patients from the respiratory intensive care unit at the People's Hospital of Rugao,Jiangsu Province from January 2019 to January 2022 were selected as research subjects.The ARDS patients were divided into three groups based on disease severity:mild(n=44),moderate(n=32)and severe(n=34).Pearson correlation analysis was conducted to assess the relationship between serum FGF⁃21,MIP⁃1αand Activin⁃A levels and the APACHEⅡscore.Based on the 28⁃day survival outcomes,patients were classified as a survival group(n=78),and a death group(n=32)for further analysis.Logistic regression was used to identify risk factors associated with mortality in ARDS patients,while receiver operating characteristics(ROC)curve analysis was used to evaluate the prognostic value of the above indicators in ARDS patients.Results Serum FGF⁃21 levels decreased progressively from mild to severe groups(mild>moderate>severe,P<0.05),while MIP⁃1αand Activin⁃A levels showed an opposite trend(severe>moderate>mild,P<0.05).Prognostic analysis revealed that the non⁃survival group had signifi⁃cantly lower FGF⁃21 levels and higher MIP⁃1αand Activin⁃A levels compared to the survival group(P<0.05).Correlation analysis demonstrated that plasma FGF⁃21 was negatively correlated with APACHE II scores(r=-0.569),while MIP⁃1α(r=0.498)and Activin⁃A(r=0.633)showed positive correlations(P<0.05).Multi⁃variate logistic regression analysis showed that a low level of FGF⁃21,high level of MIP⁃1α,and high level of Activin⁃A were independent risk factors for death in ARDS patients(P<0.05).ROC curve analysis showed that the sensitivity of FGF⁃21,MIP⁃1α,and Activin⁃A in predicting ARDS death were 0.738,0.761 and 0.699,the specificity was 0.805,0.752 and 0.774,and the AUC value was 0.787,0.833 and 0.778,respectively.The sensitivity,specificity and AUC were 0.806,0.832 and 0.899 respectively(P<0.05).The combined detection of these three markers yielded higher diagnostic performance with a sensitivity of 0.806,specificity of 0.832,and AUC of 0.899(P<0.05).Conclusion Serum levels of FGF⁃21,MIP⁃1α,and Activin⁃A correlate with ARDS severity and outcomes,demonstrating prognostic value that may serve as reference indicators for clinical diagnosis and treatment.
作者
周颖
卢坤琴
刘海梅
ZHOU Ying;LU Kunqin;LIU Haimei(Department of Respiratory Medicine,Rugao Hospital Affiliated to Nantong University,Jiangsu Rugao People's Hospital,Rugao,Jiangsu,China,226500)
出处
《分子诊断与治疗杂志》
2025年第1期116-119,共4页
Journal of Molecular Diagnostics and Therapy
基金
江苏省卫生健康委员会科研课题(MSZ2022083)。
