CAJ | 학술논문

目的探讨血浆血管性血友病因子抗原(vWF:Ag)、蛋白C(PC)活性在急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者早期诊断和预后判断中意义.方法对49例ALI/ARDS患者和21例非ALI/ARDS患者分别测定血浆vWF:Ag和PC活性,并进行急性生理及慢性健康状况(APACHE)Ⅱ评分和肺损伤评分(LIS),进一步将ALI/ARDS患者按预后、病因和器官衰竭数目(除肺外)分组,计算病死率,对结果进行比较.利用受试者工作特征(ROC)曲线评价vWF:Ag和PC活性的诊断分辨度.结果与非ALI/ARDS组相比,ALI/ ARDS组病死率和LIS评分明显升高,PaO2/FiO2明显降低,ALI/ARDS组患者血浆vWF:Ag (104％～752％)明显增高(P =0.026),而PC活性(14％～125％)明显降低(P =0.002).ALI/ARDS患者中死亡组、感染组和≥2个器官功能衰竭组血浆vWF:Ag明显高于对照组,而PC活性明显低于对照组,感染组和≥2个器官功能衰竭组病死率明显高于对照组.PC活性对预测ALI/ARD准确性较好(AUC=0.709,95％ CI:0.588～0.811,P=0.002),PC活性≤83％时,预测ALI/ARDS的敏感度和特异性分别为77.75％和57.14％,而vWF:Ag在预测ALL/ARDS准确性较差(AUC =0.584,95％ CI:0.460～0.701,P=0.243).结论血浆vWF:Ag升高和PC活性降低对判断ALI/ARDS预后都有重要作用,血浆vWF:Ag越高,PC活性越低则预后越差；但在预测ALI/ARDS上有差异,血浆PC活性预测ALI/ARDS的准确性较好,而血浆vWF:Ag预测ALI/ARDS的诊断价值有争议.
목적 탐토혈장혈관성혈우병인자항원(vWF:Ag)、단백C(PC)활성재급성폐손상(ALI)/급성호흡군박종합정(ARDS)환자조기진단화예후판단중의의.방법 대49례ALI/ARDS환자화21례비ALI/ARDS환자분별측정혈장vWF:Ag화PC활성,병진행급성생리급만성건강상황(APACHE)Ⅱ평분화폐손상평분(LIS),진일보장ALI/ARDS환자안예후、병인화기관쇠갈수목(제폐외)분조,계산병사솔,대결과진행비교.이용수시자공작특정(ROC)곡선평개vWF:Ag화PC활성적진단분변도.결과 여비ALI/ARDS조상비,ALI/ ARDS조병사솔화LIS평분명현승고,PaO2/FiO2명현강저,ALI/ARDS조환자혈장vWF:Ag (104％～752％)명현증고(P =0.026),이PC활성(14％～125％)명현강저(P =0.002).ALI/ARDS환자중사망조、감염조화≥2개기관공능쇠갈조혈장vWF:Ag명현고우대조조,이PC활성명현저우대조조,감염조화≥2개기관공능쇠갈조병사솔명현고우대조조.PC활성대예측ALI/ARD준학성교호(AUC=0.709,95％ CI:0.588～0.811,P=0.002),PC활성≤83％시,예측ALI/ARDS적민감도화특이성분별위77.75％화57.14％,이vWF:Ag재예측ALL/ARDS준학성교차(AUC =0.584,95％ CI:0.460～0.701,P=0.243).결론 혈장vWF:Ag승고화PC활성강저대판단ALI/ARDS예후도유중요작용,혈장vWF:Ag월고,PC활성월저칙예후월차；단재예측ALI/ARDS상유차이,혈장PC활성예측ALI/ARDS적준학성교호,이혈장vWF:Ag예측ALI/ARDS적진단개치유쟁의.