摘要
目的 探讨血清巨噬细胞迁移抑制因子(MIF)、单核细胞趋化蛋白-1(MCP-1)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平与脓毒症严重程度及合并急性呼吸窘迫综合征(ARDS)风险的关系.方法 回顾性分析2022年2月至2023年5月太原钢铁(集团)有限公司总医院收治的86例脓毒症患者的临床资料.依据病情程度不同将患者分为脓毒症组(n=20)、严重脓毒症组(n=48)和脓毒症休克组(n=18).入院72h内参考ARDS诊断标准将患者分为ARDS 组(n=27)和非 ARDS组(n=59).检测并比较各组脓毒症患者血清MIF、MCP-1、suPAR水平.收集ARDS组与非ARDS组患者年龄、性别、体重指数、合并症、感染类型、既往史、心率、急性生理学和慢性健康状况评价Ⅱ(APACHE Ⅱ)、脓毒症相关性器官衰竭评价(SOFA)评分、白细胞计数、血乳酸、天冬氨酸转移酶(AST)、丙氨酸转移酶(ALT)、总胆固醇等指标.采用多因素Logistic回归分析对影响脓毒症患者并发ARDS的危险因素进行分析.通过受试者工作特征(ROC)曲线分析血清MIF、MCP-1、suPAR水平预测脓毒症患者并发ARDS的价值.结果 脓毒症休克组患者血清 MIF、MCP-1、suPAR 水平分别为(94.02±10.13)、(506.55±45.15)、(13.89±3.95)ng/mL,均高于脓毒症组[(76.93±7.01)、(148.38±35.74)、(6.07±2.13)ng/mL]和严重脓毒症组[(85.46±8.74)、(327.08±40.62)、(8.42± 1.07)ng/mL],而严重脓毒症组患者血清MIF、MCP-1、suPAR水平均高于脓毒症组,差异均有统计学意义(P＜0.05).ARDS组与非ARDS组患者的年龄、性别构成比、体重指数、合并症、感染类型、白细胞计数、心率、吸烟史、饮酒史、血乳酸、AST、ALT、总胆固醇比较,差异均无统计学意义(P＞0.05);ARDS组患者APACHE Ⅱ评分、SOFA评分、有急腹症和胰腺炎占比及血清MIF、MCP-1、suPAR水平均高于非ARDS组,差异均有统计学意义(P＜0.05).经多因素Logistic回归分析结果显示,急腹症、胰腺炎、APACHE Ⅱ评分、SOFA评分、MIF、MCP-1、suPAR是影响脓毒症患者并发ARDS的独立危险因素(P＜0.05).经ROC曲线分析结果显示,血清MIF、MCP-1、suPAR水平均能预测脓毒症患者ARDS的发生,曲线下面积分别为0.904、0.910、0.917,预测价值较好(P＜0.05).结论 血清MIF、MCP-1、suPAR水平与脓毒症患者病情程度、并发ARDS密切相关,且血清MIF、MCP-1、suPAR水平对ARDS的发生有较好的预测价值.
Abstract
Objective To explore the relationship between serum levels of macrophage migration inhibitory factor(MIF),monocyte che-moattractant protein-1(MCP-1),soluble urokinase type plasminogen activator receptor(suPAR)and the severity of sepsis and the risk of a-cute respiratory distress syndrome(ARDS).Methods A retrospective analysis was conducted on the clinical data of 86 sepsis patients admitted to General Hospital of Taiyuan Steel(Group)Co.,Ltd from February 2022 to May 2023.According to the severity of the condition,patiennts were divided into sepsis group(n=20),severe sepsis group(n=48),and septic shock group(n=18).Within 72 hours of admission,pa-tients were divided into the ARDS group(n=27)and the non ARDS group(n=59)based on the diagnostic criteria for ARDS.And the levels of serum MIF,MCP-1,and suPAR in all patients were detected and compared in each group of sepsis patients.Age,gender,body mass index,comorbidities,infection type,history,heart rate,acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ),sepsis-related organ failure assessment(SOFA)score,white blood cell count,blood lactate,aspartate aminotransferase(AST),alanine aminotransferase(ALT)and total cholesterol between the ARDS group and the non ARDS group were collected.The risk factors for ARDS in sepsis patients were analyzed using multivariate Logistic regression.The value of serum MIF,MCP-1,and suPAR levels in predicting ARDS in sepsis patients was analyzed through receiver operating characteristic(ROC)curves.Results The levels of serum MIF,MCP-1,and suPAR in the septic shock group were(94.02 ±10.13),(506.55±45.15),(13.89±3.95)ng/mL,which were higher than those in the sepsis group[(76.93±7.01),(148.38±35.74),(6.07±2.13)ng/mL]and severe sepsis group[(85.46±8.74),(327.08±40.62),(8.42±1.07)ng/mL],the levels of serum MIF,MCP-1,and suPAR in patients of the severe sepsis group were higher than those in the sepsis group,the differences were statistically significant(P＜0.05).There was no statistically significant difference in age,gender composition ratio,body mass index,comorbidities,infection type,white blood cell count,heart rate,smoking history,alcohol consumption history,blood lactate,AST,ALT,and total cholesterol between the ARDS group and the non ARDS group(P＞0.05).The APACHE Ⅱ score,SOFA score,proportion of patients with acute abdomen and pancreatitis,and serum levels of MIF,MCP-1,and suPAR in the ARDS group were higher than those in the non ARDS group,the differences were statistical-ly significant(P＜0.05).Multivariate Logistic regression analysis showed that acute abdomen,pancreatitis,APACHE Ⅱ score,SOFA score,MIF,MCP-1,and suPAR were independent factors affecting sepsis patients with ARDS(P＜0.05).ROC curve analysis showed that serum MIF,MCP-1 and suPAR levels could predict the occurrence of ARDS in sepsis patients,and the areas under the curve were 0.904,0.910 and 0.917 respectively,with good predictive value(P＜0.05).Conclusion The levels of serum MIF,MCP-1,and suPAR are closely related to the severity of sepsis and the occurrence of ARDS in patients,and serum MIF,MCP-1,and suPAR levels have good predictive value for the oc-currence of ARDS.
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