血管生成素—1水平变化预测脓毒症急性肺损伤的价值(1)
摘 要：目的 探讨血管生成素-1动态变化预测脓毒症急性肺损伤形成的价值。方法 选取2016年6月～2017年6月收入我院ICU行PICCO监测的脓毒症患者43例，按照血管外肺水指数分为损伤组16例和非损伤组27例，选择健康体检者20例为对照组。所有患者入院时及入院后第1、2、3天早晨抽取静脉血离心后取血清，采用酶联免疫吸附法检测Ang-1血清水平，同时测量对应的EVLWI值。比较两组间Ang-1水平的差异，运用接收者工作特征曲线下面积检测Ang-1水平变化差值的预测效力。结果 与对照组比较，脓毒症患者发病后血清Ang-1水平升高，差异具有统计学意义(P<0.05)；损伤组与非损伤组比较，第3天与入院时血清Ang-1水平的差值升高，差异具有统计学意义(P<0.05)，第1、2天与入院时血清Ang-1水平差值两组间比较，差异无统计学意义(P>0.05)；第3天与入院时血清Ang-1水平差值预测肺损伤的曲线下面积为0.759(P<0.01，95%CI：0.565～0.905)，最佳截断点为6.5 ng/ml。结论 发病后第3天明显升高的Ang-1对判断脓毒症肺损伤的形成有一定的临床价值。
, 百拇医药
关键词：血管生成素-1；血管外肺水指数；脓毒症；急性肺损伤
中图分类号：R459.7 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.13.027
文章编号：1006-1959(2018)13-0095-04
Abstract：Objective To investigate the value of angiopoietin-1 dynamic changes in predicting the formation of acute lung injury in sepsis.Methods From June 2016 to June 2017，43 patients with sepsis who were monitored by PICCO in our hospital ICU were enrolled.According to the extravascular lung water index，16 patients were included in the injury group and 27 patients were in the non-injury group.20 healthy subjects were selected as the control group.All patients were enrolled in the venous blood at the time of admission and on the morning of the first，second，and third days after admission.The serum level of Ang-1 was detected by enzyme-linked immunosorbent assay，and the corresponding EVLWI value was measured.The difference in Ang-1 levels between the two groups was compared，and the predictive power of the difference in Ang-1 levels was measured using the area under the receiver operating characteristic curve.Results Compared with the control group，the serum Ang-1 level increased after the onset of sepsis，the difference was statistically significant(P<0.05)；The difference of the serum Ang-1 level between the third days and the admission was higher in the injury group than in the non injury group，and the difference was statistically significant(P<0.05).The difference between the first，second days and the level of serum Ang-1 level between the two groups was not statistically significant(P>0.05)，the difference in serum Ang-1 levels on day 3 and admission was predicted to be 0.759 (P<0.01，95%CI：0.565 to 0.905)and the best cut-off point was 6.5 ng/ml.Conclusion Ang-1，which is significantly elevated on the third day after onset，has certain clinical value in judging the formation of lung injury in sepsis.
, 百拇医药
Key words：Angiopoietin-1；Extravascular lung water index；Sepsis；Acute lung injury
膿毒症发病率高是重症医学领域研究的热点问题，也是患者死亡的重要原因，其相应的炎症反应导致器官血管内皮损伤，通透性增加，从而引起脏器损害。脓毒症相关急性肺损伤的发生率为18%～40%，表现为损伤性肺水肿[1]，损伤严重时患者需进行机械通气维持生命。脉搏指数连续心排量监测(pulse indicator continuous cardiac output，PiCCO)广泛用于危重患者血流动力学检测，其血管外肺水指数(EVLWI)作为肺水肿的定量检测指标能够客观准确地反映肺损伤的程度，当患者EVLWI>7 ml/kg时常常提示有肺损伤形成[2]。PICCO监测费用高，同时增加导管相关血流感染机会。血管生成素-1(angiopoietin-1，Ang-1)表达于不同细胞，如平滑肌细胞、巨核细胞、血小板等，作用于血管内皮细胞Ang/Tie-2信号通路，与家族中的Ang-2起相互拮抗作用来调节血管通透性[3]。动物及临床实验证实明显增高的Ang-1与ALI/ARDS相关[4]。本研究动态观察脓毒症患者血清Ang-1水平及EVLWI值的变化，探讨血清Ang-1动态变化预测脓毒症患者急性肺损伤形成的价值。, 百拇医药(温占兵)
, 百拇医药
关键词：血管生成素-1；血管外肺水指数；脓毒症；急性肺损伤
中图分类号：R459.7 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.13.027
文章编号：1006-1959(2018)13-0095-04
Abstract：Objective To investigate the value of angiopoietin-1 dynamic changes in predicting the formation of acute lung injury in sepsis.Methods From June 2016 to June 2017，43 patients with sepsis who were monitored by PICCO in our hospital ICU were enrolled.According to the extravascular lung water index，16 patients were included in the injury group and 27 patients were in the non-injury group.20 healthy subjects were selected as the control group.All patients were enrolled in the venous blood at the time of admission and on the morning of the first，second，and third days after admission.The serum level of Ang-1 was detected by enzyme-linked immunosorbent assay，and the corresponding EVLWI value was measured.The difference in Ang-1 levels between the two groups was compared，and the predictive power of the difference in Ang-1 levels was measured using the area under the receiver operating characteristic curve.Results Compared with the control group，the serum Ang-1 level increased after the onset of sepsis，the difference was statistically significant(P<0.05)；The difference of the serum Ang-1 level between the third days and the admission was higher in the injury group than in the non injury group，and the difference was statistically significant(P<0.05).The difference between the first，second days and the level of serum Ang-1 level between the two groups was not statistically significant(P>0.05)，the difference in serum Ang-1 levels on day 3 and admission was predicted to be 0.759 (P<0.01，95%CI：0.565 to 0.905)and the best cut-off point was 6.5 ng/ml.Conclusion Ang-1，which is significantly elevated on the third day after onset，has certain clinical value in judging the formation of lung injury in sepsis.
, 百拇医药
Key words：Angiopoietin-1；Extravascular lung water index；Sepsis；Acute lung injury
膿毒症发病率高是重症医学领域研究的热点问题，也是患者死亡的重要原因，其相应的炎症反应导致器官血管内皮损伤，通透性增加，从而引起脏器损害。脓毒症相关急性肺损伤的发生率为18%～40%，表现为损伤性肺水肿[1]，损伤严重时患者需进行机械通气维持生命。脉搏指数连续心排量监测(pulse indicator continuous cardiac output，PiCCO)广泛用于危重患者血流动力学检测，其血管外肺水指数(EVLWI)作为肺水肿的定量检测指标能够客观准确地反映肺损伤的程度，当患者EVLWI>7 ml/kg时常常提示有肺损伤形成[2]。PICCO监测费用高，同时增加导管相关血流感染机会。血管生成素-1(angiopoietin-1，Ang-1)表达于不同细胞，如平滑肌细胞、巨核细胞、血小板等，作用于血管内皮细胞Ang/Tie-2信号通路，与家族中的Ang-2起相互拮抗作用来调节血管通透性[3]。动物及临床实验证实明显增高的Ang-1与ALI/ARDS相关[4]。本研究动态观察脓毒症患者血清Ang-1水平及EVLWI值的变化，探讨血清Ang-1动态变化预测脓毒症患者急性肺损伤形成的价值。, 百拇医药(温占兵)