中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
7期
786-790
,共5页
林锦乐%王伟%田方%王立军%张文武
林錦樂%王偉%田方%王立軍%張文武
림금악%왕위%전방%왕립군%장문무
克拉拉细胞蛋白16%急性呼吸窘迫综合征%早期诊断%危重病患者%受试者工作特征曲线
剋拉拉細胞蛋白16%急性呼吸窘迫綜閤徵%早期診斷%危重病患者%受試者工作特徵麯線
극랍랍세포단백16%급성호흡군박종합정%조기진단%위중병환자%수시자공작특정곡선
Clara cell protein 16%Acute respiratory distress syndrome%Early diagnosis%Critically ill patients%Receiver operating characteristic curve
目的 探究克拉拉细胞蛋白16 (clara cell protein 16,Cc16)用于重症患者早期诊断急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床价值.方法 2013年3月至12月期间入住深圳市宝安区人民医院重症医学科的55例危重病患者纳入研究,原发病纳入标准为肺炎、脓毒症、多发伤、急诊或择期术后或非心源性疾病;排除标准为心源性肺水肿、发病超过一周、年龄＜18岁或＞80岁.每名患者入科时留取血清标本,采用酶联免疫吸附法定量检测血清Cc16水平,同时完成其他生化指标检测及基本资料收集、APACHE Ⅱ评分;根据患者资料回顾性划分为ARDS组与非ARDS组,并依据ARDS柏林诊断标准对ARDS患者进行分级.结果 采用受试者工作特征曲线计算出Cc16对ARDS诊断的曲线下面积为0.92,敏感度及特异度分别为92％和80％,高于APECHEⅡ评分、D-二聚体、CRP、NT-BNP以及血清白蛋白,其中最佳临界值为20.62 ng/L;两因素相关分析结果发现ARDS患者氧合指数与血清Cc16水平呈现负相关,其Pearson相关系数为r=-0.342 (P=0.04);单因素方差分析各亚组的组间差异,采用单因素方差分析得出结果F=15.76提示总体组间存在差异性(P =0.005 17),其中重度组(64.18±12.95)ng/mL高于中度组(38.66±20.14) ng/mL(P=0.004 9)和轻度组的(35.87±11.28) ng/mL(P =0.001 14),但轻度组与中度组差异无统计学意义(P=0.682).血清Cc16水平与患者呼吸支持类型、呼吸支持天数、120 h生存率、28 d生存率、ICU住院时间、总住院时间差异无统计学意义.结论 本研究提示血清Cc16水平对于早期诊断ARDS发生具有较高价值,并可作为ARDS柏林标准分级的参考指标.
目的 探究剋拉拉細胞蛋白16 (clara cell protein 16,Cc16)用于重癥患者早期診斷急性呼吸窘迫綜閤徵(acute respiratory distress syndrome,ARDS)的臨床價值.方法 2013年3月至12月期間入住深圳市寶安區人民醫院重癥醫學科的55例危重病患者納入研究,原髮病納入標準為肺炎、膿毒癥、多髮傷、急診或擇期術後或非心源性疾病;排除標準為心源性肺水腫、髮病超過一週、年齡＜18歲或＞80歲.每名患者入科時留取血清標本,採用酶聯免疫吸附法定量檢測血清Cc16水平,同時完成其他生化指標檢測及基本資料收集、APACHE Ⅱ評分;根據患者資料迴顧性劃分為ARDS組與非ARDS組,併依據ARDS柏林診斷標準對ARDS患者進行分級.結果 採用受試者工作特徵麯線計算齣Cc16對ARDS診斷的麯線下麵積為0.92,敏感度及特異度分彆為92％和80％,高于APECHEⅡ評分、D-二聚體、CRP、NT-BNP以及血清白蛋白,其中最佳臨界值為20.62 ng/L;兩因素相關分析結果髮現ARDS患者氧閤指數與血清Cc16水平呈現負相關,其Pearson相關繫數為r=-0.342 (P=0.04);單因素方差分析各亞組的組間差異,採用單因素方差分析得齣結果F=15.76提示總體組間存在差異性(P =0.005 17),其中重度組(64.18±12.95)ng/mL高于中度組(38.66±20.14) ng/mL(P=0.004 9)和輕度組的(35.87±11.28) ng/mL(P =0.001 14),但輕度組與中度組差異無統計學意義(P=0.682).血清Cc16水平與患者呼吸支持類型、呼吸支持天數、120 h生存率、28 d生存率、ICU住院時間、總住院時間差異無統計學意義.結論 本研究提示血清Cc16水平對于早期診斷ARDS髮生具有較高價值,併可作為ARDS柏林標準分級的參攷指標.
목적 탐구극랍랍세포단백16 (clara cell protein 16,Cc16)용우중증환자조기진단급성호흡군박종합정(acute respiratory distress syndrome,ARDS)적림상개치.방법 2013년3월지12월기간입주심수시보안구인민의원중증의학과적55례위중병환자납입연구,원발병납입표준위폐염、농독증、다발상、급진혹택기술후혹비심원성질병;배제표준위심원성폐수종、발병초과일주、년령＜18세혹＞80세.매명환자입과시류취혈청표본,채용매련면역흡부법정량검측혈청Cc16수평,동시완성기타생화지표검측급기본자료수집、APACHE Ⅱ평분;근거환자자료회고성화분위ARDS조여비ARDS조,병의거ARDS백림진단표준대ARDS환자진행분급.결과 채용수시자공작특정곡선계산출Cc16대ARDS진단적곡선하면적위0.92,민감도급특이도분별위92％화80％,고우APECHEⅡ평분、D-이취체、CRP、NT-BNP이급혈청백단백,기중최가림계치위20.62 ng/L;량인소상관분석결과발현ARDS환자양합지수여혈청Cc16수평정현부상관,기Pearson상관계수위r=-0.342 (P=0.04);단인소방차분석각아조적조간차이,채용단인소방차분석득출결과F=15.76제시총체조간존재차이성(P =0.005 17),기중중도조(64.18±12.95)ng/mL고우중도조(38.66±20.14) ng/mL(P=0.004 9)화경도조적(35.87±11.28) ng/mL(P =0.001 14),단경도조여중도조차이무통계학의의(P=0.682).혈청Cc16수평여환자호흡지지류형、호흡지지천수、120 h생존솔、28 d생존솔、ICU주원시간、총주원시간차이무통계학의의.결론 본연구제시혈청Cc16수평대우조기진단ARDS발생구유교고개치,병가작위ARDS백림표준분급적삼고지표.
Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.
