急性呼吸窘迫综合征患者血清sTM水平变化及对预后的预测价值

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摘要目的研究急性呼吸窘迫综合征（ARDS）患者血清可溶性血栓调节蛋白（sTM）水平变化及对预后的预测价值。方法以2018年12月—2019年12月武汉市第三医院收治的96例ARDS患者作为观察组，根据氧合指数（OI）分为轻度组（25例）、中度组（53例）和重度组（18例）。根据患者28 d后生存情况分为生存组（46例）和死亡组（50例），另择同期入院的48名健康体检者为对照组。比较观察组和对照组、不同程度组ARDS患者、不同结局组患者血清sTM水平和急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）的差异，分析血清sTM水平和APACHE Ⅱ评分的相关性，绘制ROC生存曲线分析血清sTM水平和APACHE Ⅱ评分对ARDS患者预后的预测价值。结果观察组血清sTM水平和APACHE Ⅱ评分均高于对照组，差异有统计学意义（P ＜ 0.05）。不同程度组ARDS患者血清sTM水平和APACHE Ⅱ评分比较，差异有统计学意义（P ＜ 0.05），且重度组各指标水平高于中度组和轻度组，中度组各指标水平高于轻度组，差异有统计学意义（P ＜ 0.05）。血清sTM水平与APACHE Ⅱ评分呈正相关（r = 0.691，P ＜ 0.05）。生存组血清sTM水平和APACHE Ⅱ评分均显著低于死亡组，差异有统计学意义（P ＜ 0.05）。ROC曲线结果显示，血清sTM水平对ARDS患者预后的预测效能高于APACHE Ⅱ评分（P ＜ 0.05）。结论 sTM可能参与ARDS的病情发展过程，且其水平变化可作为判断ARDS患者病情程度和预后的早期生物标志物。

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	陈雯雯1 叶嗣颖2 陈桂蓝2

关键词 ：急性呼吸窘迫综合征, 可溶性血栓调节蛋白, 预后, 变化

Abstract：Objective To study the changes of serum soluble thrombomodulin (sTM) levels and its prognostic value in patients with acute respiratory distress syndrome (ARDS). Methods A total of 96 patients with ARDS admitted to Wuhan Third Hospital from December 2018 to December 2019 were selected as the observation group, they were divided into mild group (25 cases) and moderate group (53 cases) and severe group (18 cases) according to the oxygenation index (OI). Patients were divided into survival group (46 cases) and death group (50 cases) according to their survival status after 28 days. Another 48 healthy persons who were admitted to the hospital during the same period were selected as the control group. The difference in serum sTM level and acute physiology and chronic health score Ⅱ (APACHE Ⅱ) between the observation group and the control group, ARDS patients of different degrees, and different outcome groups were compared, while the correlation between serum sTM level and APACHE Ⅱ score were analyzed. ROC survival curve was drew and to analyze the predictive value of serum sTM level and APACHE Ⅱ score on the prognosis of ARDS patients. Results The serum sTM level and APACHE Ⅱ score of the observation group were higher than those of the control group, and the differences were statistically significant (P ＜ 0.05). Comparison of serum sTM levels and APACHE Ⅱ scores of ARDS patients in different degree groups showed statistically significant differences (P ＜ 0.05), and the levels of indexes in the severe group were higher than those in the moderate and mild groups, while the levels in the moderate group were higher than those in the mild group, and the differences were statistically significant (P ＜ 0.05). Serum sTM level was positively correlated with APACHE Ⅱ score (r = 0.691, P ＜ 0.05). The serum sTM level and APACHE Ⅱ score of the survival group were significantly lower than those of the death group, and the differences were statistically significant (P ＜ 0.05). ROC curve results showed that the predictive power of serum sTM level on the prognosis of ARDS patients was higher than the APACHE Ⅱ score (P ＜ 0.05). Conclusion sTM may be involved in the progression of ARDS, and its level changes can be used as an early biomarker to judge the severity and prognosis of ARDS patients.

Key words： Acute respiratory distress syndrome Soluble thrombomodulin Prognosis Changes

基金资助:湖北省卫生和计划生育委员会科研项目（WJ2017E068）。

作者简介: 陈雯雯（1984.1-），女，硕士；研究方向：生化免疫。

引用本文:

陈雯雯1 叶嗣颖2 陈桂蓝2. 急性呼吸窘迫综合征患者血清sTM水平变化及对预后的预测价值[J]. 中国医药导报, 2021, 18(2): 16-19.
CHEN Wenwen1 YE Siying2 CHEN Guilan2. Changes of serum sTM levels and its prognostic value in patients with acute respiratory distress syndrome. 中国医药导报, 2021, 18(2): 16-19.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2021/V18/I2/16

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