目的: 探讨半乳糖凝集素-9（Gal-9）鉴别儿童脓毒症合并急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）的临床价值。方法: 本研究属于回顾性分析。收集2020年3月―2022年5月于西安交通大学第一附属医院儿童重症监护室（PICU）年龄为1个月至18岁且符合脓毒症诊断标准的儿科患者为研究对象。根据是否合并ARDS将患者分为脓毒症不合并ARDS组（n=60）和脓毒症合并ARDS组（n=60）。通ELISA试剂盒检测血浆Gal-9和炎症分子白细胞介素（interleukin,IL）-6、肿瘤坏死因子（tumor necrosis factor,TNF）-α和IL-1β水平。使用Spearman相关系数分析血浆Gal-9和炎症分子的相关性。通过ROC曲线分析血浆Gal-9水平对脓毒症并发ARDS的诊断价值。根据Gal-9临界值将患者分为两组,比较两组患者的生存曲线。结果: 与脓毒症不合并ARDS组相比,脓毒症合并ARDS组患者的Gal-9、IL-6、TNF-α、IL-1β水平显著增加。血浆Gal-9水平与TNF-α、IL-6和IL-1β水平呈正相关（r=0.391、0.427、0.296,均P<0.05）。当Gal-9值为265 pg/mL时,Gal-9的接收者操作特征曲线下面积（area under the ROC curve,AUROC）为0.804（95%CI：0.684~0.883,P<0.001）。血浆Gal-9水平预测脓毒症伴ARDS的敏感度和特异度分别为0.853和0.600,以及阳性预测值（PPV）、阴性预测值（NPV）和约登指数（Youden指数）分别为69.1%、81.8%和0.367。在脓毒症患者和脓毒症并发ARDS患者中,Gal-9水平≥265 pg/mL时的28天存活率比Gal-9水平<265 pg/mL时显著降低。结论: Gal-9可能作为脓毒症患者ARDS早期预测的生物标志物,并有助于预测患儿存活率。
Abstract
Objective To explore the clinical value of galectin -9(Gal-9) in differentiating acute respiratory distress syndrome (ARDS) from sepsis in children. Methods This study was a retrospective analysis. From March 2020 to May 2022, pediatric patients aged from 1 month to 18 years in PICU of the First Affiliated Hospital of Xi'an Jiaotong University were recruited as the research object. Patients were divided into sepsis group without ARDS (n=60) and sepsis group with ARDS (n=60). The levels of plasma Gal-9 and inflammatory molecules IL-6, TNF-α and IL-1β were analyzed by ELISA kit. Spearman correlation coefficient was used to analyze the correlation between plasma Gal-9 and inflammatory molecules. The diagnostic value of plasma Gal-9 in sepsis complicated with ARDS was analyzed by ROC curve. Patients were divided into two groups according to the Gal-9 critical value, and the survival curves of the two groups were compared. Results Compared with sepsis without ARDS, the levels of Gal-9, IL-6, TNF-α and IL-1β in sepsis with ARDS increased significantly. The level of plasma Gal-9 was positively correlated with the levels of TNF-α, IL-6 and IL-1β (r=0.391, 0.427 and 0.296, all P<0.05). When the critical value of Gal-9 was 265 pg/ml, the AUROC of Gal-9 was 0.804(95%CI 0.684-0.883, P<0.001). The sensitivity and specificity of plasma Gal-9 level in predicting sepsis with ARDS were 0.853 and 0.600, respectively, and the PPV, NPV and Youden indexes were 69.1%, 81.8% and 0.367, respectively. In patients with sepsis and sepsis complicated with ARDS, the 28-day survival rate was significantly lower when the Gal-9 level was ≥265 pg/mL than when the Gal-9 level was <265 pg/mL. Conclusions Gal-9 can be used as a biomarker for early prediction of ARDS in septic patients, and it is helpful to predict the survival rate.
关键词
半乳糖凝集素-9 /
脓毒症 /
急性呼吸窘迫综合征 /
儿童 /
预后
Key words
galectin-9 /
sepsis /
acute respiratory distress syndrome /
children /
prognosis
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基金
陕西省卫生健康委员会科研项目“半乳糖凝集素-9在小儿脓毒症合并急性呼吸窘迫综合中的运用价值”（S20212335）
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