摘要
目的:分析血清与支气管肺泡灌洗液（BALF）中细胞因子水平与肺内外急性呼吸窘迫综合征（ARDS）的相关性。方法:采用单中心回顾性研究方法，收集山东省立医院重症医学科自2021年8月至2022年1月收治的所有需要行机械通气的ARDS患者的临床资料，根据纳入标准和排除标准，最终纳入30例。根据ARDS肺损伤因素将其分为2组：直接肺损伤引起的肺内组和间接肺损伤引起的肺外组。采集患者一般临床资料，细胞因子水平［白介素（IL）-6、IL-10、IL-1β、肿瘤坏死因子（TNF-α）、IL-8］，中性粒细胞比率（Neu%）、淋巴细胞比率（Lym%），疾病严重程度及临床结局，临床生物学指标等。连续变量相关性分析采用Spearman分析，不同类型ARSD的影响因素采用logistic回归分析。结果:肺外组机械通气时间低于肺内组，差异有统计学意义（Z=2.593，P=0.008）；除血清中Lym%，BALF中IL-10，BALF/血清IL-10比值、BALF/血清TNF-α比值、BALF/血清Neu%比值差异无统计学意义外，2组血清和BALF中余细胞因子及Neu%、Lym%等比较，差异均有统计学意义（P＜0.05）；Spearman相关性分析显示，肺内组BALF/血清中IL-1β比值与机械通气时间具有正相关（r=0.773，P=0.015）；logistic回归分析显示，血清中的TNF-α和Neu%与不同原因引起的ARDS具有明显相关性（OR=2.833，95%CI：1.136~7.063，P=0.025；OR=0.879，95%CI：0.776~0.995，P=0.041）。结论:BALF/血清中IL-1β水平仅与肺内组ARDS患者机械通气时间呈显著正相关；虽然肺内和肺外不同原因ARDS患者的血清和BALF中多数细胞因子表达水平存在明显区别，但血清中TNF-α和Neu%能区分两者。
Abstract
Objective:To analyze the correlation between the cytokine levels in serum and bronchoalveolar lavage fluid (BALF) and intrapulmonary and extrapulmonary acute respiratory distress syndrome (ARDS).Methods:A single-center retrospective study was conducted to collect the clinical data of all ARDS patients requiring mechanical ventilation who were admitted to the Department of Critical Care Medicine of Shandong Provincial Hospital from August 2021 to January 2022. According to the inclusion criteria and exclusion criteria, 30 patients were finally included. ARDS patients were divided into intrapulmonary group caused by direct lung injury and extrapulmonary group that caused by indirect lung injury. Clinical data, cytokine levels (IL -6, IL-10, IL-1β, TNF-α, IL-8), neutrophil ratio (Neu%), lymphocyte ratio (Lym%), disease severity and clinical outcome and clinical biological indicators were collected. Spearman analysis was used for correlation analysis of continuous variables, and logistic regression analysis was used to determine the influencing factors of different type of ARDS.Results:The duration of mechanical ventilation in extrapulmonary group was shorter than that in intrapulmonary group (Z=2.593, P=0.008). There were no significant differences of serum Lym%, BALF IL-10, BALF/serum IL-10, BALF/serum TNF-α and BALF/serum Neu% while significant differences in other variables between the two groups (P<0.05). Spearman correlation analysis showed that the level of IL-1β in BALF/ serum was positively correlated with the duration of mechanical ventilation in the intrapulmonary group (r=0.773, P=0.015). Logistic regression analysis showed that serum TNF-α and Neu% were the influencing factors of ARDS patients (OR=2.833, 95%CI: 1.136-7.063, P=0.025; OR=0.879, 95%CI: 0.776-0.995, P=0.041).Conclusion:The level of IL-1β in BALF/serum is positively correlated with the duration of mechanical ventilation inpatients with intrapulmonary ARDS. Although the expression levels of cytokines in serum and BALF are significantly different between patients with intrapulmonary and extrapulmonary ARDS, TNF-α and Neu% in serum can distinguish them.
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