The value of Galectin-9 in children with sepsis complicated with acute respiratory distress syndrome
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目的:探讨半乳糖凝集素-9(Gal-9)鉴别儿童脓毒症合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床价值.方法:本研究属于回顾性分析.收集2020年3月―2022年5月于西安交通大学第一附属医院儿童重症监护室(PICU)年龄为1个月至18岁且符合脓毒症诊断标准的儿科患者为研究对象.根据是否合并ARDS将患者分为脓毒症不合并ARDS组(n=60)和脓毒症合并ARDS组(n=60).通ELISA试剂盒检测血浆Gal-9和炎症分子白细胞介素(interleukin,IL)-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α和IL-1β水平.使用Spearman相关系数分析血浆Gal-9和炎症分子的相关性.通过ROC曲线分析血浆Gal-9水平对脓毒症并发ARDS的诊断价值.根据Gal-9临界值将患者分为两组,比较两组患者的生存曲线.结果:与脓毒症不合并ARDS组相比,脓毒症合并ARDS组患者的Gal-9、IL-6、TNF-α、IL-1β水平显著增加.血浆Gal-9水平与TNF-α、IL-6和IL-1β水平呈正相关(r=0.391、0.427、0.296,均P<0.05).当Gal-9值为265 pg/mL时,Gal-9的接收者操作特征曲线下面积(area under the ROC curve,AUROC)为0.804(95%CI:0.684～0.883,P<0.001).血浆Gal-9水平预测脓毒症伴ARDS的敏感度和特异度分别为0.853和0.600,以及阳性预测值(PPV)、阴性预测值(NPV)和约登指数(Youden指数)分别为69.1%、81.8%和0.367.在脓毒症患者和脓毒症并发ARDS患者中,Gal-9水平≥265 pg/mL时的28天存活率比Gal-9水平＜265 pg/mL时显著降低.结论:Gal-9可能作为脓毒症患者ARDS早期预测的生物标志物,并有助于预测患儿存活率.
Objective To explore the clinical value of galectin-9(Gal-9)in differentiating acute respiratory distress syndrome(ARDS)from sepsis in children.Methods This study was a retrospective analysis.From March 2020 to May 2022,pediatric pa-tients aged from 1 month to 18 years in PICU of the First Affiliated Hospital of Xi'an Jiaotong University were recruited as the re-search object.Patients were divided into sepsis group without ARDS(n=60)and sepsis group with ARDS(n=60).The levels of plasma Gal-9 and inflammatory molecules IL-6,TNF-α and IL-1β were analyzed by ELISA kit.Spearman correlation coefficient was used to analyze the correlation between plasma Gal-9 and inflammatory molecules.The diagnostic value of plasma Gal-9 in sepsis complicated with ARDS was analyzed by ROC curve.Patients were divided into two groups according to the Gal-9 critical value,and the survival curves of the two groups were compared.Results Compared with sepsis without ARDS,the levels of Gal-9,IL-6,TNF-α and IL-1β in sepsis with ARDS increased significantly.The level of plasma Gal-9 was positively correlated with the levels of TNF-α,IL-6 and IL-1β(r=0.391,0.427 and 0.296,all P<0.05).When the critical value of Gal-9 was 265 pg/ml,the AUROC of Gal-9 was 0.804(95%CI 0.684-0.883,P<0.001).The sensitivity and specificity of plasma Gal-9 level in predict-ing sepsis with ARDS were 0.853 and 0.600,respectively,and the PPV,NPV and Youden indexes were 69.1%,81.8%and 0.367,respectively.In patients with sepsis and sepsis complicated with ARDS,the 28-day survival rate was significantly lower when the Gal-9 level was≥265 pg/mL than when the Gal-9 level was<265 pg/mL.Conclusions Gal-9 can be used as a biomarker for early prediction of ARDS in septic patients,and it is helpful to predict the survival rate.
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