本文關(guān)鍵詞：早期膿毒癥合并ARDS患者EVLWI，Ang2，vWF與新柏林分級(jí)及預(yù)后評(píng)價(jià)的探討　出處：《鄭州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 血小板假血友病因子(vWF) 脈搏指示持續(xù)心排血量(PiCCO) 血管生成素-2(Ang-2) 血管外肺水指數(shù)(EVLWI) 預(yù)后 膿毒癥 急性呼吸窘迫綜合征(ARDS)

【摘要】：目的評(píng)價(jià)血管外肺水指數(shù)(EVLWI)結(jié)合Ang-2、v WF,與早期膿毒癥合并急性呼吸窘迫綜合征(ARDS)患者的柏林標(biāo)準(zhǔn)嚴(yán)重程度分級(jí)的相關(guān)性,探討對(duì)疾病嚴(yán)重程度及預(yù)后評(píng)估的應(yīng)用價(jià)值。方法回顧性分析2013年1月至2014年6月入住鄭州大學(xué)第一附屬醫(yī)院重癥醫(yī)學(xué)科的41例行脈搏指示持續(xù)心排血量(Pi CCO)監(jiān)測(cè)的早期膿毒癥合并ARDS患者的臨床資料,并根據(jù)入科時(shí)氧合指數(shù)(Pa O2/Fi O2)分為輕度、中度、重度三組,觀測(cè)的終點(diǎn)指標(biāo)為28天死亡率,按28天預(yù)后分為存活組及死亡組。所有患者均于入重癥加強(qiáng)治療病房(ICU)起始0時(shí)、第1天、第2天、第3天時(shí)采用Pi CCO檢測(cè)儀監(jiān)測(cè)EVLWI,用酶聯(lián)免疫吸附試驗(yàn)(ELISA)檢測(cè)上述同一時(shí)間點(diǎn)的血漿Ang-2、v WF水平;記錄入選時(shí)的患者一般資料和機(jī)械通氣時(shí)間及住ICU時(shí)間;計(jì)算急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ)評(píng)分和序貫器官衰竭評(píng)分(SOFA);比較生存組和死亡組ARDS患者EVLWI、Ang-2、v WF指標(biāo)間差異;對(duì)這些指標(biāo)和氧合指數(shù)進(jìn)行相關(guān)性分析;繪制受試者工作特征曲線(ROC),評(píng)價(jià)各指標(biāo)對(duì)預(yù)后的價(jià)值。結(jié)果共回顧性收集41例早期膿毒癥合并ARDS患者,28 d存活22例,死亡19例。死亡組除APACHEⅡ、EVLWI、Ang-2評(píng)分均明顯高于存活組(均P0.01),ICU住院時(shí)間明顯短于存活組外,其他基線資料如性別、年齡、感染來源、機(jī)械通氣時(shí)間與存活組比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。隨治療時(shí)間延長,存活組EVLWI逐漸下降,死亡組逐漸升高;死亡組入ICU 0、1、2、3 d時(shí)EVLWI均明顯高于存活組〔EVLWI(ml/kg)0d:13.67±6.16比9.82±2.81,t=3.324,P=0.038;1 d:14.05±6.29比9.13±2.70,t=3.732,P=0.032;2 d:14.58±6.89比8.82±2.40,t=4.738,P=0.001;3 d:15.32±6.71比7.50±1.95,t=5.225,P=0.000〕。兩組血漿Ang-2水平均先升后降,死亡組入ICU 0、1、2、3 d時(shí)血漿Ang-2水平均明顯高于存活組〔Ang-2(ng/L)0 d:402.41±227.54比259.47±153.52,t=4.879,P=0.000;1 d:409.36±212.31比279.22±140.83,t=4.138,P=0.014;2d:439.72±207.56比318.76±168.65,t=3.327,P=0.038;3 d:425.66±204.89比302.94±167.04,t=3.979,P=0.022〕。兩組血漿v WF水平均逐漸上升,死亡組入ICU 0、1、2、3 d時(shí)血漿v WF數(shù)值均高于存活組,但無統(tǒng)計(jì)學(xué)差異〔v WF(U/L)0 d:615.72±603.14比527.75±576.59,t=0.807,P=0.543;1 d:602.53±553.20比515.04±689.15,t=0.789,P=0.625;2 d:799.06±842.15比718.31±762.67,t=0.837,P=0.492;3 d:841.62±782.93比806.95±610.49,t=0.911,P=0.461〕。入ICU 0d時(shí),各個(gè)指標(biāo)均沒有相關(guān)性(均P0.05)。入ICU1、2、3 d時(shí)Ang-2與EVLWI均呈顯著正相關(guān)(r1=0.605、r2=0.458、r3=0.392,1、2d均P0.01,3d P0.05)。入ICU 1、2、3d時(shí)Ang-2與Pa O2/Fi O2均呈負(fù)相關(guān)(r1=-0.656、r2=-0.429、r3=-0.354,均P0.01,3d P0.05),EVLWI與Pa O2/Fi O2均呈負(fù)相關(guān)(r1=-0.739、r2=-0.473、r3=-0.388,均P0.01)。入ICU1、2、3 d時(shí)v WF與Pa O2/Fi O2無明顯相關(guān)性(r1=-0.107、r2=0.075、r3=0.345,均P0.05)。ROC曲線分析顯示,入ICU 1 d時(shí)Ang-2的ROC曲線下面積(AUC)為0.778±0.075,截?cái)嘀禐?15.15ng/L時(shí),評(píng)估預(yù)后的敏感度為84.21%,特異度為68.18%;入ICU 3 d時(shí)EVLWI的AUC為0.818±0.068,截?cái)嘀禐?2.5 m L/kg時(shí),評(píng)估預(yù)后的敏感度為63.16%,特異度為95.45%;二者的預(yù)后評(píng)估價(jià)值均優(yōu)于同時(shí)間點(diǎn)APACHEⅡ、SOFA評(píng)分。1 d時(shí)Ang-2聯(lián)合EVLWI的AUC為0.844±0.064,截?cái)嘀禐?.483時(shí),評(píng)估預(yù)后的敏感度為88.42%,特異度為90.91%;入ICU 3 d時(shí)Ang-2聯(lián)合EVLWI的AUC為0.828±0.066,截?cái)嘀禐?.646時(shí),評(píng)估預(yù)后的敏感度為84.65%,特異度為95.45%,二者均較其他單獨(dú)評(píng)價(jià)指標(biāo)具有更好的預(yù)后評(píng)估價(jià)值(均P0.01)。結(jié)論Ang-2可作為早期膿毒癥合并ARDS的一個(gè)實(shí)用的血清學(xué)指標(biāo),EVWLI和Ang-2與柏林分級(jí)呈負(fù)相關(guān)性,v WF因子與柏林分級(jí)無相關(guān)性,Ang-2與EVLWI呈明顯正相關(guān),Ang-2與EVLWI聯(lián)合可為臨床早期評(píng)估膿毒癥合并ARDS患者的病情及預(yù)測(cè)預(yù)后、并針對(duì)高�；颊叻e極進(jìn)行干預(yù)治療提供參考。
[Abstract]:Extravascular lung water index (EVLWI) combined with Ang-2, V WF, and the early stage of sepsis with acute respiratory distress syndrome (ARDS) patients in Berlin relative grade standard severity, investigate the application value of assessment of disease severity and prognosis. Methods Retrospective analysis indicates continuous cardiac output in ICU. The First Affiliated Hospital of Zhengzhou University from January 2013 to June 2014 in the 41 patients who received pulse (Pi CCO) clinical data monitoring early sepsis in patients with ARDS, and according to the Department of oxygenation index (Pa O2/Fi O2) were divided into mild, moderate and severe group three, end point indicators observed for 28 day mortality, according to 28 days the prognosis is divided into survival group and death group. All patients in the ICU (ICU) starting at 0, first days, second days, third days when using the Pi CCO tester monitoring EVLWI by enzyme-linked immunosorbent assay (ELISA) detection of the above The plasma levels of Ang-2 at the same time, the level of WF V; records selected when the general data of patients and the duration of mechanical ventilation and ICU stay; and chronic health evaluation II calculation of acute physiology (APACHE II) and sequential organ failure assessment score (SOFA); to compare the survival group and death group of patients with ARDS EVLWI Ang-2. V WF, the difference between the index and the index; oxygenation index correlation analysis; receiveroperating characteristic curve (ROC), to evaluate the value of each index on the prognosis. Results of 41 cases of patients with early sepsis in patients with ARDS were reviewed, 28 d 22 cases survived, 19 cases died. The death group in addition to APACHE II, EVLWI, Ang-2 scores were significantly higher than the survival group (P0.01), ICU hospitalization time was significantly shorter than the survival group, other baseline data such as gender, age, source of infection, the difference of mechanical ventilation time and survival group had no statistical significance (P0.05) with the treatment. Prolonged survival group EVLWI decreased gradually, the death group increased gradually; the death group 0,1,2,3 into ICU D EVLWI were significantly higher than the survival group, EVLWI (ml/kg) 0d:13.67 + 6.16 to 9.82 + 2.81, t=3.324, P=0.038; 1 d:14.05 + 6.29 9.13 + 2.70, t=3.732, P=0.032; 2 d:14.58 + 6.89 + 8.82 2.40, t=4.738, P=0.001; 3 d:15.32 + 6.71 to 7.50 + 1.95, t=5.225, P=0.000. The plasma Ang-2 levels of the two groups were decreased, the death group ICU 0,1,2,3 d into the plasma level of Ang-2 was higher than the survival group, Ang-2 (ng/L) d:402.41 0 + 227.54 to 259.47 + 153.52, t=4.879, P=0.000; 1 d:409.36 + 212.31 to 279.22 + 140.83, t=4.138, P=0.014; 2d:439.72 + 207.56 to 318.76 + 168.65, t=3.327, P=0.038; 3 d:425.66 + 204.89 302.94 + 167.04, t=3.979, P=0.022. The plasma V WF levels of the two groups were gradually increased, the death group into the ICU D 0,1,2,3 data of the plasma V WF was higher than that of the survival group, But there was no significant difference in V WF (U/L) d:615.72 0 + 603.14 to 527.75 + 576.59, t=0.807, P=0.543; 1 d:602.53 + 553.20 515.04 + 689.15, t=0.789, P=0.625; 2 d:799.06 + 842.15 718.31 + 762.67, t=0.837, P=0.492; 3 d:841.62 + 782.93 to 806.95 + 610.49, t= 0.911, P=0.461. In ICU 0d, each index had no correlation (P0.05). ICU1,2,3 D Ang-2 was positive correlated with EVLWI (r1=0.605, r2=0.458, r3=0.392,1,2d P0.01,3d P0.05 ICU 1,2,3d). In Ang-2 and Pa O2/Fi O2 were negatively correlated (r1=-0.656, R2, =-0.429, r3=-0.354, P0.01,3d, P0.05) there was negative correlation between EVLWI and Pa O2/Fi O2 (r1=-0.739, r2=-0.473, r3=-0.388, P0.01). D WF and V ICU1,2,3 Pa O2/Fi O2 had no significant correlation (r1=-0.107, r2=0.075, r3=0.345, P0.05).ROC curve analysis showed that the area of 1 ROC d into the ICU curve under Ang-2 (AUC) 0.778 + 0.075, The cut-off value of 315.15ng/L, the prognostic sensitivity was 84.21%, specificity was 68.18%; ICU 3 D EVLWI AUC was 0.818 + 0.068, the cut-off value of 12.5 m L/kg, the prognostic sensitivity was 63.16%, specificity was 95.45%; prognostic value of two were superior to the time point APACHE II, SOFA.1 D Ang-2 combined with EVLWI score AUC was 0.844 + 0.064, when the cutoff value was 0.483, the prognostic sensitivity was 88.42%, specificity was 90.91%; ICU 3 D Ang-2 AUC combined with EVLWI was 0.828 + 0.066, when the cutoff value was 0.646, the sensitivity of prognostic evaluation 84.65%, the specificity was 95.45%, prognostic value was higher than that of the other two individual evaluation indexes are better (P0.01). Conclusion Ang-2 can be used as a useful serological index of early sepsis with ARDS, EVWLI and Ang-2 in Berlin and there was a negative correlation between V grading, WF grading and Berlin related factor Sex, Ang-2 and EVLWI were positively correlated. Ang-2 and EVLWI combination can be used for early clinical evaluation of sepsis and ARDS patients' condition and prognosis, and provide reference for high-risk patients with active intervention.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R459.7

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