目的 观察可溶性晚期糖基化终末产物受体(sRAGE)对脓毒症性急性呼吸窘迫综合征(ARDS)的诊断价值及乌司他丁对脓毒症性ARDS的干预作用.方法 选取2012年3月至2015年6月新疆医科大学附属中医医院收治的58例脓毒症性ARDS患者,根据柏林会议ARDS分级新标准将所有患者分为轻度ARDS组(20例)、中度ARDS组(23例)及重度ARDS组(15例),另选取58例肺损伤评分为0的患者作为非ARDS组.比较4组患者动脉血氧分压(PaO2)/吸入氧浓度(FiO2)比值及血浆sRAGE水平,并分析PaO2/FiO2比值与sRAGE水平的相关性.再将58例脓毒症性ARDS患者按照单中心随机分组原则分为观察组和对照组,各29例.对照组给予临床常规治疗,观察组在对照组的基础上加用乌司他丁注射液治疗7d,比较2组治疗前后PaO2/FiO2比值和C反应蛋白(CRP)、降钙素原水平.结果 非ARDS组和轻、中、重度ARDS组患者PaO2/FiO2比值分别为(415 ±43)、(264±32)、(175±28)、(69±18)mmHg(l mmHg=0.133 kPa),sRAGE水平分别为(542±132)、(1 525±185)、(2 352±323)、(3 126 ±542) pg/L,两两比较差异均有统计学意义(均P＜0.05).相关性分析显示,脓毒症性ARDS组患者的PaO2/FiO2比值与血浆sRAGE水平呈负相关(r=-0.935,P=0.0003).治疗前,观察组和对照组PaO2/FiO2比值、CRP、降钙素原水平差异均无统计学意义(均P＞0.05);治疗后,观察组和对照组PaO2/FiO2比值均明显高于治疗前[(309±97) mmHg比(167±32) mmHg,(251±64) mmHg比(162±38) mmHg],CRP和降钙素原水平均明显低于治疗前[CRP:(29±12) mg/L比(76±25) mg/L,(40±18) mg/L比(77±23) mg/L;降钙素原:(10±9)ng/L比(29±13) ng/L,(20±10) ng/L比(30±11) ng/L],且观察组PaO2/FiO2比值明显高于对照组,CRP、降钙素原水平明显低于对照组,差异均有统计学意义(均P＜0.05).结论 脓毒症性ARDS患者血浆sRAGE水平越高病情越严重,sRAGE可作为判断脓毒症性ARDS严重程度的指标.乌司他丁能够有效减轻脓毒症性ARDS患者的炎性反应且改善其氧合情况.%Objective To analyze the diagnostic value of soluble receptor for advanced glycation endproducts(sRAGE) and the clinical effect of ulinastatin on septic acute respiratory distress syndrome (ARDS).Methods Totally 58 patients with septic ARDS from March 2012 to June 2015 in the Affiliated Chinese Medicine Hospital of Xinjiang Medical University were divided into 2 groups according to ARDS Berlin definition:mild ARDS group(20 cases),moderate ARDS group(23 cases) and severe ARDS group(15 cases).Other 58 cases without lung injury from general wards in our hospital were selected as non-ARDS group.Arterial partial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2) and plasma sRAGE level were analyzed.All 58 cases of septic ARDS were randomly and equally divided into observation group and control group.The control group was given routine treatment;the observation group was given routine treatment and ulinastatin injection for 7 days.PaO2/FiO2,C reactive protein(CRP) and procalcitonin were analyzed.Results In non-ARDS group,mild,moderate and severe ARDS groups,PaO2/FiO2 were (415 ±43),(264 ±32),(175 ±28),(69 ± 18)mmHg and sRAGE were (542 ± 132),(1 525 ± 185),(2 352 ± 323),(3 126 ± 542) pg/L,respectively;differences among 4 groups were all significant (P ＜ 0.05).Correlation analysis showed that PaO2/FiO2 was negatively correlated with sRAGE (r =-0.935,P =0.000 3).Before treatment,PaO2/FiO2,CRP and procalcitonin had no significant differences between observation group and control group(P ＞0.05).After treatment,PaO2/FiO2 were significantly higher,and CRP and procalcitonin were significantly lower than those before treatment in both groups [PaO2/FiO2:(309 ±97)mmHg vs (167 ±32)mmHg,(251 ±64) mmHg vs (162 ±38) mmHg;CRP:(29 ± 12) mg/L vs (76 ± 25) mg/L,(40 ± 18) mg/L vs (77 ± 23) mg/L;calcitonin:(10 ± 9) ng/L vs (29 ± 13)ng/L,(20 ± 10) ng/L vs (30 ± 11) ng/L];PaO2/FiO2 in observation group was significantly higher,and CRP and calcitonin were significantly lower than those in control group (P ＜ 0.05).Conclusions The plasma level of sRAGE can be an indicator for evaluating the severity of sepsis ARDS.Ulinastatin can effectively relieve inflammatory reaction and improve oxygenation in patients with septic ARDS.
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