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Received:August 02, 2019 Published Online:May 20, 2020
Received:August 02, 2019 Published Online:May 20, 2020
中文摘要: 目的 探讨血浆可溶性血栓调节蛋白(sTM)对急性呼吸窘迫综合征(ARDS)儿童预后的预测价值。方法 收集2015年5月至2019年5月收治的58例ARDS患儿的临床基本资料,并选择同期入院的45例普通肺炎患儿作为对照组。同时根据氧合指数将收治入院的ARDS患儿分为轻中度ARDS组(PaO2/FiO2 100~300 mm Hg)44例与重度ARDS组(PaO2/FiO2≤100 mm Hg)14例,并按照患儿28 d生存情况分为生存组(n=44)与死亡组(n=14)。检测入PICU 6 h内时患儿的sTM、N末端B型利钠肽(NT-BNP)、肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnI)、乳酸脱氢酶(LDH)、血乳酸等指标,并通过受试者工作特征曲线(ROC)评估sTM对ARDS患儿预后的预测价值。结果 轻中度ARDS组和重度ARDS组患儿的sTM、CK-MB、NT-BNP水平均高于对照组,且重度ARDS组各指标水平高于轻中度ARDS组(P<0.01),但三组LDH、cTnI水平比较无统计学差异(P>0.05)。入PICU 6 h内,两组患儿的左心室短袖缩短率、LVEF、左心房内径以及CK-MB、cTnI、LDH、NT-BNP水平比较均无统计学差异(P>0.05);但存活组血浆sTM水平低于死亡组,差异有统计学意义(P<0.05)。经ROC曲线分析结果显示,血浆sTM作的曲线下面积为0.779,95%CI为0.528~0.845),截点值为6.5 ng/ml,预测28 d病死率的敏感度为73.9%,特异度为86.8%。结论 血浆sTM水平在ARDS儿童中显著升高,可作为患儿发生心肌损害的敏感指标,能够反映疾病严重程度,且对于患儿的预后具有重要的预测价值。
Abstract:ObjectiveTo investigate the prognostic value of plasma soluble thrombomodulin（sTM）in children with acute respiratory distress syndrome（ARDS）.MethodsFifty-eight ARDS children in pediatric intensive care units (PICU) from May 2015 to May 2019 were selected as ARDS group,and 45 children with common bronchial pneumonia admitted to hospital were served as control group in the same period.According to oxygenation index,ARDS group was subdivided into mild to moderate ARDS group（PaO2/FiO2 100-300 mm Hg,n=44）and severe ARDS group（PaO2/FiO2≤100 mm Hg,n=14）and were subdivided into survival group（n=44）and death group（n=14）according to their 28-day survival status.The levels of sTM,N-terminal B-type natriuretic peptide (NT-BNP),creatine kinase-MB isoenzyme (CK-MB),cardiac troponin I (cTnI),lactate dehydrogenase (LDH),blood lactate and other indexes were detected within 6 hours after admission to PICU,and the prognostic value of sTM in children with ARDS was evaluated by receiver operating characteristic(ROC) curve.ResultsThe levels of sTM,CK-MB and NT-BNP in two ARDS groups were significantly higher than those in control group and were statistically higher in severe ARDS group than those in mild to moderate ARDS group (P<0.01),but there were no statistical differences in the levels of LDH and cTnI between three groups(P>0.05).Within 6 hours after admission to PICU,there were no significant differences in the shortening rate of left ventricular short-axis,LVEF,left atrial diameter,levels of CK-MB,cTnI,LDH,NT-BNP between survival group and death group(P>0.05),but the plasma sTM level in survival group was statistically lower than that in death group (P<0.05).ROC curve showed that the area under ROC (AUC) of plasma sTM was 0.779 (95% CI,0.528-0.845),with the cut-off point of 6.5 ng/ml.In predicting 28-day mortality,plasma sTM had sensitivity of 73.9% and specificity of 86.8%.ConclusionPlasma sTM level is significantly increased in children with ARDS and can be used as a sensitive indicator of myocardial damage,reflecting the severity of the disease,and it has important predictive value for the prognosis of ARDS children.
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基金项目:江苏省科技厅基础研究计划(自然科学基金)(BK20161033)
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