细胞外组蛋白对ARDS早期诊断和预后评估的临床价值

目的 探究细胞外组蛋白对急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）早期诊断和预后评估的临床价值。方法 选择2017年1月—2018年6月同济大学附属上海市肺科医院和北京市朝阳医院急诊重症监护病房（emergency intensive care unit, EICU）收治的ARDS患者67例，并以15名健康志愿者作为健康对照组。根据28d转归情况将ARDS患者分为生存组（38例）和死亡组（29例）。测定ARDS患者血清中细胞外组蛋白的水平，比较细胞外组蛋白在健康对照组和ARDS患者中的差异以及细胞外组蛋白与ARDS患者预后的相关性；受试者工作特征曲线（ROC）分析细胞外组蛋白对ARDS早期诊断及预后评估的价值。结果 和对照组相比，ARDS患者的血清细胞外组蛋白水平明显升高（P<0.0001），且与患者的预后密切相关（P<0.01）。ROC曲线显示细胞外组蛋白（1d）对于ARDS的早期诊断的AUC为0.8985，细胞外组蛋白（3d）对于判断ARDS患者预后的AUC为0.8154。结论 细胞外组蛋白水平对ARDS的早期诊断和预后评估具有重要参考临床价值。

Clinical value of serum extracellular histones in early diagnosis and prognosis evaluation of acute respiratory distress syndrome

Objective To investigate the clinical value of serum extracellular histones in early diagnosis and prognosis evaluation of acute respiratory distress syndrome(ARDS). Methods Sixty seven patients with ARDS admitted in emergency intensive care unit(EICU) of Shanghai Pulmonary Hospital and Beijing Chaoyang Hospital from January 2017 to June 2018 were enrolled. According to 28-day mortality, ARDS patients were divided into survival group(n=38), and fatal group(n=29), and 15 healthy subjects served as controls. The levels of serum extracellular histones were measured, and compared between ARDS patients and controls. The value of extracellular histones in diagnosis and prognosis of ARDS was assessed with receiver operation characteristic curve(ROC). Results Serum extracellular histones levels in ARDS patients were significantly higher than those in the healthy controls(P<0.0001), and were closely correlated with the prognosis of ARDS(P<0.01). The area under the curve(AUC) of extracellular histones at d1 for the early diagnosis of ARDS was 0.8985; the AUC of extracellular histones at d3 for the prediction of 28d-mortality for ARDS patients was 0.8154. Conclusion Serum extracellular histones possess clinically valuable in early diagnosis and prognosis assessment of ARDS.