sCD163在急性呼吸窘迫综合征中的预后评估价值

摘要

目的 明确sCD163血清浓度在急性呼吸窘迫综合症患者中的诊断和预后评估价值.方法 共有124人纳入本次研究,包括急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者83名,心源性肺水肿(cardiogenic pulmonary edema,CPE)患者20名,21名健康对照.根据ARDS患者28天死亡率,将其分为存活组和非存活组.EHSA方法测定sCD163血清浓度,ROC曲线评价sCD163诊断和评估ARDS患者28天死亡率的准确性,采用Kaplan-Meier生存分析计算累及生存曲线,Logistic回归分析明确影响死亡率的独立预测因子.结果 ARDS患者的sCD163平均值明显比CPE患者高[496.7(421.8～577.5)ng/mL vs.284.5(141.7～459.2) ng/mL,P＜0.001].非存活组的ARDS患者sCD163水平明显高于存活组[577.5(503.7～623.4) ng/mL vs.479.6 (395.4～520.8) ng/mL,P＜0.001],多元Logistic回归分析表明sCD163是ALI/ARDS患者28天死亡率的独立预测因子(OR=2.262,P=0.034).结论 血清sCD163是诊断ARDS的潜在性标志物,可区分ARDS的严重程度,同时也是ARDS患者28天死亡率的独立预测因子.%Objective To investigate the diagnostic and prognostic value of plasma soluble CD163 (sCD163) levels in patients with acute respiratory distress syndrome (ARDS).Methods A total of 124 individuals,83 patients with ARDS,20 patients with cardiogenic pulmonary edema (CPE),and 21 healthy controls,were enrolled in this study.ARDS patients were classified into survivors and nonsurvivors according to 28-day mortality.The concentration of plasma sCD163 was measured by enzymelinked immunosorbent assay (ELISA).Receiver operating characteristic (ROC) curves were employed to evaluate the accuracy of sCD163 in diagnosing ARDS and predicting 28-day ICU outcome.Cumulative survival curve was carried out by Kaplan-Meier survival analysis.Logistic regression analysis was assessed by univariate and multivariate analysis to identify independent predictors of outcome controlling for reported risk factor of mortality.Results Patients with ARDS had significantly higher median levels of sCD163 compared to patients with CPE [496.7(421.8-577.5) ng/mL vs.284.5(141.7-459.2) ng/mL,P＜0.001] upon admission to ICU.The sCD163 levels of non-survivors was significantly higher than that of survivors [577.5 (503.7-623.4) ng/mL vs.479.6 (395.4-520.8) ng/mL,P＜0.001].Multivariate logistic regression showed sCD163 (OR =1.02,P =0.001)was the independent predictor for 28-day mortality in patients with ARDS.Conclusions Plasma sCD163 is a potential biomarker for diagnosis of ARDS and differenting the severity of ARDS.Meanwhile,sCD163 was an independent prognostic marker for 28-day mortality in ARDS patients.