目的 分析血清血管性血友病因子特异性裂解酶(a disintegrin-like and metalloprotease with thrombospondin type 1 motif,member 13,ADAMTS13)水平与接受体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗患者的预后关系.方法 本研究选取 2020 年 1 月—2022 年 6月在湖南医药学院第一附属医院接受ECMO治疗的 42 例患者,按照ECMO撤离 1 个月内预后分为生存组(n= 29)和死亡组(n= 13).通过分析接受ECMO治疗患者的血清ADAMTS13 水平,分析血清ADAMTS13 与接受ECMO治疗患者的预后.结果 生存组年龄小于死亡组(P<0.001).2 组性别和体表面积比较,差异无统计学意义(P>0.05).生存组平均动脉压为(54.24±5.81)mmHg、氧合指数为(178.84±29.38)mmHg,均高于死亡组的(52.56±4.42)mmHg、(155.71±23.12)mmHg;生存组急性生理与慢性健康评分(acute physiology and chronic health evaluation-Ⅱ,APACHE-Ⅱ)评分为(22.51±2.62)分,低于生存组的(27.35±3.85)分(P<0.05).2 组左室射血分数和ECMO流量比较,差异无统计学意义(P>0.05).ECMO治疗后,2 组血清ADAMTS13 水平升高.生存组ECMO治疗前 1 h及治疗后 24 h、48 h血清ADAMTS13 水平高于死亡组,差异有统计学意义(P<0.001).ECMO治疗48 h后血清ADAMTS13 水平为ECMO辅助治疗患者死亡的独立危险因素(P<0.001).结论 接受ECMO治疗患者的血清ADAMTS13 水平降低与预后不佳相关.
Relationship Between Serum ADAMTS13 Level and Prognosis of Patients Receiving ECMO Therapy
Objective To analyze the relationship between serum a disintegrin-like and metalloprotease with thrombospondin type 1 motif,member 13(ADAMTS13)level and prognosis of patients receiving extracorporeal membrane oxygenation(ECMO).Methods A total of 42 patients who received ECMO in the First Affiliated Hospital of Hu'nan University of Medicine from January 2020 to June 2022 were divided into survival group(n=29)and death group(n=13)according to the prognosis of patients within 1 month after ECMO withdrawal.By analyzing serum ADAMTS13 levels in patients treated with ECMO,the prognosis of serum ADAMTS13 and patients treated with ECMO was analyzed.Results The age of survival group was lower than that of death group(P<0.001).There was no significant difference in gender and body surface area between the two groups(P>0.05).The mean arterial pressure and oxygenation index of survival group were(54.24±5.81)mmHg and(178.84±29.38)mmHg,which were higher than those of death group of(52.56±4.42)mmHg and(155.71±23.12)mmHg.Acute physiology and chronic health evaluation-Ⅱ(APACHE-Ⅱ)score of survival group was(22.51±2.62)points,lower than that of death group of(27.35±3.85)points(P<0.05).There was no significant difference in left ventricular ejection fraction and ECMO flow between the two groups(P>0.05).After ECMO treatment,the level of serum ADAMTS13 increased in both groups.The serum ADAMTS13 levels in the survival group were higher than that in the death group 1 h before ECMO treatment and 24 h and 48 h after ECMO treatment,and the differences were statistically significant(P<0.001).The serum ADAMTS13 levels after 48 h of ECMO treatment were an independent risk factor for death in patients treated with ECMO adjuvant therapy(P<0.001).Conclusion Decreased serum ADAMTS13 levels in patients receiving ECMO are associated with poor prognosis.
ADAMTS13ECMOprognosisrisk factorsmean arterial pressureoxygenation index