血管外肺水、肿瘤坏死因子-α、E-选择素、血管抑制因子-2与急性呼吸窘迫综合征患者预后的相关性研究

目的：分析血管外肺水（ EVLW）、肿瘤坏死因子-α（ TNF-α）、E-选择素、血管抑制因子-2与急性呼吸窘迫综合征（ ARDS）的相关性，探讨EVLW、TNF-α、E-选择素、血管抑制因子-2在ARDS病情严重程度及预后判断中的参考价值。方法选择36例ARDS患者进行PiCCO监测，根据PiCCO监测指标血管外肺水指数（ EVLWI）的高低分为两组，EVLWI≥14 mL/kg组和EVLWI＜14 mL/kg组，监测记录患者EVLWI、PVPI、CI、ITBVI等血流动力学指标，观察患者血气分析结果，记录氧合指数、计算APACHEⅡ评分，应用ELISA方法检测两组患者血清TNF-α、E-选择素、血管抑制因子-2水平。结果 EVLWI≥14 mL/kg组患者APACHEⅡ评分为（23．93±4．44）分、28 d病死率为61．1％、ICU住院时间为（19．05±4．0） d，均较 EVLWI ＜14 mL/kg组APACHEⅡ评分为（18．58±3．66）分、28 d病死率为27．8％、ICU住院时间为（14．35±3．39）d]高（t＝3．941，χ2＝4．050，t＝3．797，均P＜0．01）；同时血清TNF-α为（85．28±18．25）μg/L、E-选择素为（74．07±14．57）μg/L，也较EVLWI＜14 mL/kg组TNF-α为（63．27±20．28）μg/L、E-选择素为（40．99±16．35）μg/L]高（t＝3．422、5．847，均P＜0．01）；EVLWI≥14 mL/kg组氧合指数为（122．86±25．45），较EVLWI＜14 mL/kg组的（156．77±37．58）低（t＝-3．170，P＜0．01）。两组中28 d内仍存活的20例患者（存活组），在入组后经72 h积极治疗后EVLWI明显下降（Z＝-0．392，P＜0．01），氧合指数较前升高（Z＝-3．845，P＜0．01），且TNF-α、E-选择素水平均较前下降（t＝7．194、4．025，均P＜0．01）；而死亡组16例患者经72 h积极治疗后EVLWI、TNF-α、E-选择素水平较前无下降，氧合指数较前无改善，差异无统计学意义（均P＞0．05）。 EVLWI 与PVPI、EVLWI 与TNF-α、EVLWI与E-选择素均呈显著正相关（r＝0．605、0．649、0．549，均P＜0．01）?

Study on relationship between extravascular lung water,TNF-a,E-selectin,vasostatin-2 and the prognosis of patients with ARDS

Objective To analyze the correlations between acute respiratory distress syndrome （ ARDS） and extravascular lung water（EVLW）,tumor necrosis factor alpha （TNF-α）,E-selectin,vasostatin-2.To discuss the value of EVLW, TNF-α, E-selectin and vasostatin-2 in evaluating the severity of ARDS and prognosis of this disease . Methods There are thirty-six patients with ARDS were selected .According to the level of EVLWI shown by pulse indicator continuous cardiac output （ PiCCO） monitor,they were divided into the two groups：EVLWI≥14mL/kg group （n=18） and EVLWI〈14mL/kg group（n=18）.To monitor and record the levels of EVLWI ,PVPI,CI,ITBV,record oxygenation index ,calculate APACHEII score .The levels of TNF-α,E-selectin and vasostatin-2 in serum were meas-ured by ELISA.Results In EVLWI≥14mL/kg group,the APACHEⅡscore was （23.93 ±4.44）,28-day mortality was 61.1%,the stay time in ICU was （19.05 ±4.0） d,which were higher than those in EVLWI 〈14mL/kg group APACHEII score （18.58 ±3.66）,28-day mortality（27.8%）,the stay time in ICU（14.35 ±3.39） d]（t=3.941,χ2 =4.050,t=3.797,all P〈0.01）.And the levels of TNF-α（85.28 ±18.25）μg/L]and E-selectin（74.07 ± 14.57）μg/L]in serum were higher than in EVLWI 〈14mL/kg groupTNF-α（63.27 ±20.28）μg/L,E-selectin （40.99 ±16.35）μg/L]（t=3.422,5.847,all P〈0.01）.The oxygenation index of EVLWI≥14mL/kg group was （122.86 ±25.45）,which was lower than that in EVLWI 〈14mL/kg group（156.77 ±37.58）]（t=-3.170,P〈0.01）.In the two groups of patients still alive within 28 days,after active treatment for 72 hours,the level of EVLWI was significantly lower than before in these 20 patients（Z=-0.392,P〈0.01）,oxygenation index was significantly higher than before（Z=-3.845,P〈0.01）,and the levels of TNF-αand E-selectin were significantly lower than before（t=7.194,4.025,all P〈0.01）.But 16 patients in the death group,after active treatment for 72 hours,the levels of EVLWI ,TNF-α,E-selectin