摘要
背景急性呼吸窘迫综合征(ARDS)患者病死率约为40%,而寻找精准评价、预测ARDS患者预后的临床标志物对改善患者预后具有重要意义。目的探讨肺源性ARDS患者预后的影响因素。方法选取2017年3月—2019年3月空军军医大学西京医院呼吸与危重医学科收治的肺源性ARDS患者167例,根据其预后分为生存组72例和死亡组95例。比较两组患者临床资料、实验室检查指标,肺源性ARDS患者预后的影响因素分析采用多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线以评价氧合指数(OI)、活化部分凝血活酶时间(APTT)对肺源性ARDS患者预后的预测价值。结果(1)两组患者年龄、男性比例、体质指数(BMI)、吸烟史、手术史、高血压病史、脓毒症病史、其他疾病病史及哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)发生率比较,差异无统计学意义(P>0.05);死亡组患者中有冠心病病史者所占比例、支气管哮喘发生率低于生存组,慢性阻塞性肺疾病(COPD)发生率、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分高于生存组,住院时间长于生存组,住院花费多于生存组(P<0.05)。(2)两组患者白介素6(IL-6)、乳酸、心肌肌钙蛋白I(cTnI)及凝血酶原时间(PT)比较,差异无统计学意义(P>0.05);死亡组患者肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)、血肌酐(Scr)、脑钠肽前体(proBNP)、心肌肌钙蛋白T(cTnT)高于生存组,OI低于生存组,APTT长于生存组(P<0.05)。(3)多因素Logistic回归分析结果显示,OI是ARDS患者预后的保护因素[OR=0.246,95%CI(0.015,4.368)],APTT是肺源性ARDS患者预后的危险因素[OR=2.979,95%CI(1.406,6.311)]。(4)ROC曲线显示,OI预测肺源性ARDS患者预后的曲线下面积为0.732[95%CI(0.647,0.816)],最佳临界值为179.85 mm Hg,灵敏度为61.5%,特异度为73.5%;APTT预测肺源性ARDS患者预后的曲线下面积为0.855[95%CI(0.793,0.916)],最佳临界值为61.79 s,灵敏度为70.9%,特异度为87.2%。结论OI、APTT是肺源性ARDS患者预后的独立影响因素,OI<179.85 mm Hg、APTT>61.79 s的肺源性ARDS患者死亡风险较高。
Background Fatality rate of acute respiratory distress syndrome(ARDS)is about 40%,thus it is of great significance to find clinical markers to accurately evaluate and predict the prognosis in patients with ARDS. Objective To explore the influencing factors of prognosis in patients with pulmonary ARDS. Methods From March 2017 to March 2019,a total of 167 patients with pulmonary ARDS were selected in the Department of Respiratory and Critical Care Medicine,Xijing Hospital of Air Force Military Medical University,and they were divided into survival group(n=72)and death group(n=95)according to their prognosis. Clinical data and laboratory examination results were compared between the two groups,and influencing factors of prognosis in patients with pulmonary ARDS were analyzed by multivariate Logistic regression analysis,moreover ROC curve was drawn to evaluate the predictive value of OI and APTT on prognosis in patients with pulmonary ARDS. Results (1)There was no statistically significant difference in age,male proportion,BMI,operation history,smoking history,hypertension history,sepsis history,other disease history or incidence of ACOS between the two groups(P>0.05);proportion of patients with CHD history and incidence of bronchial asthma in death group were statistically significantly lower than those in survival group,incidence of COPD and APACHE Ⅱ score in death group were statistically significantly higher than those in survival group,hospital stays in death group was statistically significantly longer than that in the survival group,Hospitalization cost in death group was statistically significantly higher than that in survival group(P<0.05).(2)There was no statistically significant difference in IL-6,lactic acid,c TnI or PT between the two groups(P>0.05);TNF-α,CRP,PCT,Scr,proBNP and cTnT in death group were statistically significantly higher than those in survival group,OI in death group was statistically significantly lower than that in survival group,APTT in death group was statistically significantly longer than that in survival group(P<0.05).(3)Multivariate Logistic regression analysis results showed that,OI was the protective factor of prognosis in patients with pulmonary ARDS[OR=0.246,95%CI(0.015,4.368)],while APTT was the risk factor of prognosis in patients with pulmonary ARDS[OR=2.979,95%CI(1.406,6.311)].(4)ROC curve showed that,AUC,the optimum critical value,sensitivity and specificity of IO in predicting prognosis in patients with pulmonary ARDS was 0.732[95%CI(0.647,0.816)],179.85 mm Hg,61.5% and 73.5%,respectively;AUC,the optimum critical value,sensitivity and specificity of APTT in predicting prognosis in patients with pulmonary ARDS was 0.855[95%C(I0.793,0.916)],61.79 s,70.9% and 87.2%,respectively. Conclusion OI and APTT are independent influencing factors of prognosis in patients with pulmonary ARDS,risk of death is relatively high in pulmonary ARDS patients with OI<179.85 mm Hg or APTT> 61.79 s.
作者
陈伟
宋立强
CHEN Wei;SONG Liqiang(Department of Respiratory,Yan'an Traditional Chinese Medicine Hospital,Yan'an 716000,China;Department of Respiratory and Critical Care Medicine,Xijing Hospital of Air Force Military Medical University,Xi'an 710032,China)
出处
《实用心脑肺血管病杂志》
2020年第1期43-48,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
国家自然科学基金面上项目(81570072)
陕西省社会发展科技攻关项目(2016SF-096).
关键词
急性呼吸窘迫综合征
肺炎
预后
影响因素分析
预测
Acute respiratory distress syndrome
Pneumonia
Prognosis
Root cause analysis
Forecasting
作者简介
通信作者:宋立强,E-mail:songlq@fmmu.edu.cn
