急性呼吸窘迫综合征患儿血浆可溶性血栓调节蛋白及白细胞介素-22水平变化及意义

目的观察急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患儿血浆可溶性血栓调节蛋白(soluble thrombomodulin,sTM)、白细胞介素-22(interleukin-22,IL-22)水平变化,探讨其预测ARDS患儿预后的价值。方法ARDS患儿89例为ARDS组,体检健康儿童54例为对照组。ARDS患儿根据氧合指数(oxygenation index,OI)分为轻度组(OI≥201~300mm Hg)27例,中度组(OI≥101~200mm Hg)39例,重度组(OI≤100mm Hg)23例;根据住院28d内生存或死亡情况分为死亡组33例和生存组56例。采用ELISA法检测各组血浆sTM、IL-22水平;比较轻、中、重度组ARDS患儿急性生理和慢性健康状况评估Ⅱ(acute physiological and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、OI等临床资料;比较轻、中、重度组ARDS患儿与对照组、生存组、死亡组ARDS患儿血浆sTM、IL-22水平;Pearson相关分析ARDS患儿血浆sTM、IL-22水平与OI、APACHEⅡ评分、SOFA评分的相关性;绘制ROC曲线,评估血浆sTM、IL-22预测ARDS患儿预后的价值。结果重度组APACHEⅡ评分、SOFA评分高于轻度组和中度组,OI低于轻度组和中度组(P<0.05);中度组APACHEⅡ评分、SOFA评分高于轻度组,OI低于轻度组(P<0.05)。重度组28d内病死率(78.26%)高于轻度组(18.52%)和中度组(25.64%)(P<0.05),轻度组与中度组比较差异无统计学意义(P>0.05)。轻、中、重度组血浆sTM(4.02±1.46)、(6.23±2.48)、(9.35±3.05)μg/L]、IL-22(17.59±3.82)、(25.34±4.49)、(32.65±6.59)μmol/L]水平依次升高(P<0.05),且均高于对照组(2.15±0.65)μg/L、(4.05±1.35)μmol/L](P<0.05)。死亡组血浆sTM(9.95±1.79)μg/L]、IL-22(31.48±5.24)μmol/L]水平均高于生存组(4.25±1.54)μg/L、(20.99±4.65)μmol/L](P<0.05)。ARDS患儿血浆sTM、IL-22水平与OI呈负相关(r=-0.651,P<0.001;r=-0.679,P<0.001),与APACHEⅡ评分(r=0.502,P=0.003;r=0.568,P<0.001)、SOFA评分(r=0.521,P=0.001;r=0.549,P<0.001)呈正相关。血浆sTM以7.49μg/L为最佳截断值,预测ARDS患儿预后的AUC为0.827(95%CI:0.734~0.919,P<0.001),灵敏度为75.76%,特异度为80.36%;IL-22以27.09μmol/L为最佳截断值,预测ARDS患儿预后的AUC为0.766(95%CI:0.642~0.889,P<0.001),灵敏度为69.70%,特异度为87.50%;sTM联合IL-22预测ARDS患儿预后的AUC为0.924(95%CI:0.896~0.964,P<0.001),灵敏度为90.91%,特异度为92.86%。结论ARDS患儿血浆sTM、IL-22水平随着ARDS病情严重程度升高,二者联合对预测ARDS患儿预后有重要价值。

Changes of plasma soluble thrombomodulin and interleukin-22in children with acute respiratory distress syndrome and their significances

Objective To observe the changes of plasma soluble thrombomodulin(sTM)and interleukin-22(IL-22)levels in children with acute respiratory distress syndrome(ARDS),and to investigate the value of detection of them two to the prognosis prediction of ARDS.Methods According to oxygenation index(OI),89ARDS children were divided into 27patients with OI from 201to 300mm Hg(mild group),39patients with OI from 101to 200mm Hg(moderate group)and 23patients with OI≤100mm Hg(severe group),and were divided into death group(n=33)and survival group(n=56)according to the survival in 28days after hospitalization.And another 54healthy volunteers were as controls(control group).The plasma levels of sTM and IL-22were detected by ELISA.Acute physiological and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,OI and other clinical data were compared among mild,moderate and severe groups.The plasma levels of sTM and IL-22were compared among mild group,moderate group,severe group and control group as well as between death group and survival group.Pearson correlation analysis was performed to assess the correlations of sTM and IL-22with OI,APACHEⅡscore and SOFA score.ROC was drawn to assess the values of sTM and IL-22to the prognosis prediction of ARDS children.Results The APACHEⅡand SOFA scores were higher in severe group than those in moderate group and mild group,and higher in moderate group than those in mild group(P<0.05).OI was lower in severe group than that in moderate group and mild group(P<0.05),and lower in moderate group than that in mild group(P<0.05).The fatality rate in 28days was higher in severe group(78.26%)than that in moderate group(25.64%)and mild group(18.52%)(P<0.05),and showed no significant difference between mild and moderate groups(P>0.05).The plasma levels of sTM and IL-22 decreased gradually in turn in severe group((9.35±3.05)μg/L,(32.65±6.59)μmol/L),moderate group((6.23±2.48)μg/L,(25.34±4.49)μmol/L),mild group((4.02±1.46)μg/L,(17.59±3.82)μmol/L)and control group((2.15±0.65)μg/L,(4.05±1.35)μmol/L)(P<0.05).The sTM and IL-22levels were higher in death group((9.95±1.79)μg/L,(31.48±5.24)μmol/L)than those in survival group((4.25±1.54)μg/L,(20.99±4.65)μmol/L)(P<0.05).The plasma levels of sTM and IL-22in children with ARDS were negatively correlated with OI(r=-0.651,P<0.001;r=-0.679,P<0.001),and positively correlated with APACHEⅡscore(r=0.502,P=0.003;r=0.568,P<0.001)and SOFA score(r=0.521,P=0.001;r=0.549,P<0.001).When the optimal cut-offvalue of serum STM was 7.49μg/L,the AUCfor predicting the prognosis of ARDS children was 0.827(95%CI:0.734-0.919,P<0.001),the sensitivity was 75.76%,and the specificity was 80.36%.When the optimal cut-offvalue of IL-22was 27.09μmol/L,the AUCfor predicting the prognosis of ARDS children was 0.766(95%CI:0.642-0.889,P<0.001),the sensitivity was 69.70%,and the specificity was 87.50%.The AUCof STM+IL-22for predicting the prognosis of ARDS children was 0.924(95%CI:0.896-0.964,P<0.001),the sensitivity was 90.91%,and the specificity was 92.86%.Conclusion The plasma sTM and IL-22levels in ARDS children are elevated with the severity of disease,and the combined detection of sTM and IL-22contributes to the prognosis prediction in ARDS children.