血清Activin-A联合肺部超声评分对急性呼吸窘迫综合征严重程度及预后的评估价值

doi:10.3969/j.issn.1006-6233.2021.10.023

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摘要 目的:探讨血清激活素-A(Activin-A)联合肺部超声评分(LUS)对急性呼吸窘迫综合征(ARDS)严重程度及预后的评估价值。方法:选取我院2018年1月至2020年12月重症加强护理病房(ICU)收治的160例ARDS患者为ARDS组,根据病情严重程度分为重度组(n=80)、中度组(n=52)、轻度组(n=28),根据28d预后情况分为死亡组(n=40)和存活组(n=120),另选取同期60名体检健康者为对照组。检测血清Activin-A和LUS,Pearson相关性分析血清Activin-A水平和LUS与氧合指数(OI)的相关性,多因素Logistics回归分析ARDS预后不良影响因素,ROC曲线判断血清Activin-A联合LUS对ARDS患者预后不良的评估价值。结果:ARDS组血清Activin-A水平和LUS明显高于对照组(P<0.05)。重度组血清Activin-A水平和LUS明显高于轻、中度组,中度组血清Activin-A水平和LUS明显高于轻度组(P<0.05)。Pearson相关性分析显示,血清Activin-A水平和LUS与OI呈负相关(P<0.05)。多因素Logistics回归分析显示,OI(OR=0.957,95%CI:0.932~0.981)为ARDS预后不良独立保护因素,Activin-A(OR=1.012,95%CI:1.006~1.018)、LUS(OR=1.328,95%CI:1.128~1.564)为独立危险因素(P<0.05)。ROC曲线显示,Activin-A+LUS(AUC=0.922,95%CI:0.869~0.958)预测ARDS患者预后不良的曲线下面积(AUC)明显大于Activin-A(AUC=0.841,95%CI:0.775~0.894)、LUS(AUC=0.792,95%CI:0.721~0.852)评估,敏感度、特异度、准确度为87.04%、89.62%、88.98%。结论:血清Activin-A、LUS与ARDS病情严重程度和预后密切相关,联合检测可提升ARDS预后评估价值。

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	舒姣洁
	张妍
	郭玉梅
	刘国梁

关键词 ：急性呼吸窘迫综合征, 预后, 激活素-A, 肺部超声评分

Abstract：Objective: To explore the evaluation value of serum Activin-A (Activin-A) combined with lung ultrasound score (LUS) for the severity and prognosis of acute respiratory distress syndrome (ARDS). Methods: 160 ARDS patients admitted to the intensive care unit (ICU) of our hospital (January 2018 to December 2020) were selected. According to the severity of the disease, they were divided into severe group (n=80), moderate group (n=52), mild group (n=28); according to the 28d prognosis, they were divided into death group (n=40) and survival group (n=120), the other 60 healthy people were selected as the control group during the same period.. Detection of serum Activin-A and LUS, Pearson correlation analysis of serum Activin-A level, LUS and oxygenation index (OI) correlation, multivariate Logistics regression analysis of adverse prognostic factors of ARDS, ROC curve to determine the evaluation value of serum Activin-A combined with LUS on the poor prognosis of ARDS patients. Results: Serum Activin-A levels and LUS were significantly higher in the ARDS group than in the control group (P＜0.05). Serum Activin-A levels and LUS were significantly higher in the severe group than in the mild and moderate groups, and serum Activin-A levels and LUS were significantly higher in the moderate group than in the mild group (P＜0.05).Pearson correlation analysis showed that serum Activin-A levels and LUS were negatively correlated with OI (P<0.05). Multivariate logistic regression analysis showed that OI (OR=0.957, 95%CI: 0.932~0.981) was an independent protective factor for poor prognosis of ARDS, Activin-A (OR=1.012, 95%CI: 1.006~1.018), LUS (OR=1.328, 95%CI: 1.128~1.564) were independent risk factors (P<0.05). The ROC curve showed that the area under the curve (AUC) of Activin-A+LUS (AUC=0.922, 95%CI: 0.869~0.958) predicting poor prognosis of ARDS patients was significantly greater than that of Activin-A (AUC=0.841, 95%CI: 0.775~0.894), LUS (AUC=0.792, 95%CI: 0.721~0.852) assessment. Sensitivity, specificity, accuracy are 87.04%, 89.62%, 88.98%. Conclusion: Serum Activin-A and LUS are closely related to the severity and prognosis of ARDS, and combined detection can improve the prognostic value of ARDS.

Key words： Acute respiratory distress syndrome Prognosis Activin-A Lung ultrasound score

基金资助:辽宁省卫生计生委科研课题,(编号:20170049)

引用本文:

舒姣洁, 张妍, 郭玉梅, 刘国梁. 血清Activin-A联合肺部超声评分对急性呼吸窘迫综合征严重程度及预后的评估价值[J]. 河北医学, 2021, 27(10): 1692-1696.
SHU Jiaojie, ZHANG Yan, GUO Yumei, et al. The Evaluation Value of Serum Activin-A Combined with Lung Ultrasound Score for the Severity and Prognosis of Acute Respiratory Dstress Syndrome. HeBei Med, 2021, 27(10): 1692-1696.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.10.023 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I10/1692

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