急性呼吸窘迫综合征患者血清中白细胞介素的表达及临床意义

目的探讨急性呼吸窘迫综合征(ARDS)患者血清中白细胞介素(IL)的表达及临床意义。方法 43例ARDS患者(ARDS组)和26例无明显器质性疾病的成人(对照组)的血清,应用酶联免疫吸附(ELISA)法检测血清IL-6、IL-10、IL-13和IL-18水平。结果与对照组比较,ARDS组血清中IL-6、IL-10、IL-13和IL-18的表达均明显升高,同时其与病变分级相关。ARDS组中IL-6和IL-18、IL-10和IL-13表达具有正相关性。结论 IL-6、IL-10、IL-13和IL-18在ARDS患者血清中的表达升高,不仅对病变的形成和进展有影响,同时对病情评估有明显价值。     

急性呼吸窘迫综合征患者血清可溶性CD14、LBP水平与预后的关系研究

目的探讨急性呼吸窘迫综合征患者血清可溶性白细胞分化抗原14(soluble CD14, sCD14)、脂多糖结合蛋白(Lipopolysaccharide binding protein,LBP)水平与预后的关系。方法选取我院2014年3月至2018年3月收治的138例急性呼吸窘迫综合征患者作为研究对象,收集138例患者的临床资料,根据患者预后结局,将患者分为存活组(n=77)及死亡组(n=61)。比较两组患者血清sCD14、LBP水平,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)取确定sCD14、LBP指标最佳临界值,采用Logistic回归分析影响急性呼吸窘迫综合征患者预后的独立危险因素。结果两组患者sCD14、LBP水平比较存在明显差异,死亡组sCD14、LBP水平明显高于存活组,差异具有统计学意义(t分别为8.922、21.270,P0.001);通过ROC曲线分析结果显示,LBP的曲线下面积为0.780(95%CI 0.770-0.792)时,截断值取80.73μg/mL诊断效率最高,敏感性为81.46%,特异性为71.69%。sCD14的曲线下面积为0.745(95%CI 0.727-0.763)时,截断值取36.74μg/L预测预后死亡诊断效率最高,敏感性为80.98%,特异性为70.90%。经单因素分析,基线APACHEⅡ评分、合并疾病类型、既往饮酒史、sCD14、LBP水平是影响急性呼吸窘迫综合征患者预后死亡的单因素(P0.05);进一步Logistic多因素分析结果显示:基线APACHEⅡ评分(≥16.5分)、sCD1(≥36.74μg/L)、LBP(≥80.73μg/mL)是影响急性呼吸窘迫综合征患者预后死亡的独立危险单因素(P0.001)。结论急性呼吸窘迫综合征患者血清sCD14、LBP水平是影响预后死亡的危险因素,早期sCD14、LBP水平较高者预后死亡风险大。     

细胞因子与急性呼吸窘迫综合征

细胞因子 ( cytokines)是一类小分子量 ( <3 0 k Da)的可溶蛋白 ,在细胞间的信息传递过程中起重要作用。肺内细胞因子首先由淋巴细胞、巨噬细胞和粒细胞等产生 (自分泌 )后 ,经肺泡上皮细胞、间质细胞、纤维母细胞及血管内皮细胞等放大作用产生更多的细胞因子 (旁分泌 ) ,形成“瀑布”效应 ,加剧肺内和全身的炎症反应。随着炎症过程中炎性细胞和细胞因子的信息增多 ,细胞因子和急性呼吸窘迫综合征 ( ARDS)发病机制间的关系已引起医学界的浓厚兴趣。本文先简述细胞因子的标本采集和测定方法 ,然后重点阐明细胞因子与 ARDS的关系。1　标本…     

血清IL-10、IL-18与急性冠脉综合征的相关性研究

对45例急性冠脉综合征（ACS）患者（ACS组）、40例稳定型冠心病患者（SCHD组）及30例正常对照者的血清白细胞介素（IL-10）、IL-18水平进行测定,结果ACS组血清IL-10水平显著低于SCHD组和对照组（P均〈0．01）,血清IL-18水平显著高于SCHD组和对照组（P均〈0．01）;ACS患者血清IL-10与L-18呈显著负相关（P〈0．01）。提示血清IL-10、IL-18与不稳定粥样斑块破裂密切相关,两者共同作用促使ACS发生。     

血清FGF2表达水平与急性呼吸窘迫综合征患者病情严重程度及预后的关系

目的 分析急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者血清碱性成纤维细胞生长因子2(fibroblast growth factor 2,FGF2)表达水平与病情严重程度以及预后的关系。方法 收集2020年6月～2022年6月在我院接受治疗的ARDS患者126例作为研究对象,根据治疗后30天预后情况将其分为存活组(72例)与死亡组(54例),根据氧合指数[动脉血氧分压(arterial partial oxygen pressure, PaO₂)/吸入氧浓度(inhaled oxygen concentration, FiO₂)]分为轻度组(42例),中度组(48例),重度组(36例)。使用ELISA法检测各组血清FGF2水平;采用Spearman相关性分析ARDS患者血清FGF2的表达水平与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分之间的关系;Logistic回归分析影响ARDS患者预后的因素;运用受试者工作特征(ROC)曲线分析血清FGF2水平对ARDS患者预后...     

急性呼吸窘迫综合征患者单核细胞人类白细胞抗原DR表达及其与预后的关系

目的探讨急性呼吸窘迫综合征（ARDS）患者单核细胞人类白细胞抗原DR（HLA-DR）表达及其与预后的关系。方法2004年7月至2005年6月收住东南大学附属中大医院ICU的76例ARDS患者纳入观察。ARDS确诊当天（第1天）及确诊后第7天抽取外周血,应用流式细胞仪检测T淋巴细胞亚群占淋巴细胞百分比、单核细胞HLA-DR表达以及淋巴细胞凋亡。记录患者年龄、性别、导致ARDS的原因,及ARDS确诊当天急性生理和慢性健康（APACHE）Ⅱ评分、心率、呼吸频率、平均动脉压、氧合指数、动脉血pH、动脉血乳酸、外周血血红蛋白浓度、血小板和白细胞计数以及器官功能衰竭个数。以住院28d病死率为预后判定标准。结果与生存组比较,死亡组患者在ARDS第1天和第7天的单核细胞HLA-DR表达均无明显差异。死亡组患者ARDS第7天的单核细胞HLA-DR表达明显低于ARDS第1天。ARDS第1天HLA-DR≤30%的患者生存时间明显低于HLA-DR〉30%患者。ARDS第1天HLA-DR≤30%的患者的28d病死率为67%,有高于HLA-DR〉30%患者（42%）的趋势,但差异无统计学意义。以ARDS第1天HLA-DR≤30%作为判断患者死亡指标,其灵敏度为97%,但特异度仅为17%。以ARDS第1天单核细胞HLA-DR表达判断患者预后的ROC曲线下面积为0.553（P=0.618）,以患者第1天和第7天单核细胞HLA-DR表达变化判断预后的ROC曲线下面积为0.830（P〈0.01）。患者ARDS第1天及第7天HLA-DR表达与APACHEⅡ评分和器官功能衰竭数均无相关性。严重感染导致的ARDS患者的生存时间明显低于其他原因导致的ARDS患者。结论单核细胞HLA-DR≤30%可提示ARDS患者预后不良,HLA-DR表达动态下降对预后判断也具有一定价值。     

白介素-10在急性呼吸窘迫综合征中的作用

前炎症因子的释放是急性呼吸窘迫综合征(ARDS)发生和发展的主要因素之一，白介素-10可以抑制巨噬细胞等炎症细胞的活性，抑制前炎症因子的产生，从而对ARDS的发生和发展产生一定的作用，并对预测该病的预后有一定的意义。     

急性冠状动脉综合征患者血清白细胞介素-10、18及肿瘤坏死因子α水平及其临床意义

目的:评价血清白细胞介素(IL)-18、肿瘤坏死因子α(TNF-α)和IL-10水平与急性冠状动脉综合征(ACS)的关系及其临床意义。方法:冠心病(CHD)患者91例,分为ACS组、稳定型心绞痛(SAP)组;非CHD患者55例作为对照组,采用ELISA法测定血清IL-18、TNF-α和IL-10浓度并分析。结果:CHD患者血清IL-18和TNF-α水平明显高于对照组(P<0.01),而血清IL-10明显低于对照组(P<0.01);与SAP组相比,ACS组血清IL-18和TNF-α水平明显升高(P<0.01),而血清IL-10水平则显著降低(P<0.01)。且随着冠状动脉狭窄程度的增加,IL-18的水平逐渐增高。结论:IL-18、TNF-α和IL-10可以反映动脉粥样硬化斑块的严重程度和稳定状态,可作为监测病情的临床生化指标。     

新生儿急性呼吸窘迫综合征患儿血清miR-877-5p表达变化及其与病情严重程度和预后的关系

目的 探讨新生儿急性呼吸窘迫综合征（NARDS）患儿血清微小RNA-877-5p(miR-877-5p)表达变化及其临床意义。方法 选择NARDS患儿95例（观察组）,病情严重程度：轻度38例、中度35例、重度22例,28 d内临床结局：死亡21例、存活74例,同期选择健康新生儿40例作为对照组。采集所有研究对象外周静脉血,离心留取血清,采用实时荧光定量聚合酶链式反应检测血清miR-877-5p表达,采用酶联免疫吸附试验检测血清IL-1β、IL-6、TNF-α。采用Spearman相关分析法分析NARDS患儿血清miR-877-5p表达与氧指数和血清IL-1β、IL-6、TNF-α水平的关系。采用受试者工作特征（ROC）曲线分析血清miR-877-5p表达对NARDS诊断和预后的预测价值。结果 观察组血清miR-877-5p表达低于对照组,血清IL-1β、IL-6、TNF-α水平高于对照组（P均<0.01）。随着病情严重程度增加,NARDS患儿血清miR-877-5p表达逐渐降低,血清IL-1β、IL-6、TNF-α水平逐渐升高（P均<0.01）。Spearman相关分析显...     

血清白蛋白和前白蛋白对ARDS患者死亡预后的评估作用

目的观察急性呼吸窘迫综合征（ARDS）患者入院血清白蛋白和前白蛋白与死亡预后的关系,探讨其能否作为死亡预后的指标。方法回顾性分析住院ARDS患者50例临床资料,了解不同血清白蛋白和前白蛋白水平对病死率的影响,并进行多因素Logistic回归分析,筛选死亡预后的风险因素。结果死亡28例,存活22例。死亡组患者的血清白蛋白、前白蛋白水平低于存活组（P〈0．05）,肺损伤积分大于存活组（P〈0．05）。低前白蛋白组病死率高于前白蛋白正常或升高组;低白蛋白组病死率高于正常白蛋白组（P〈0．05）。慢性阻塞性肺疾病（COPD）史、糖尿病史,白蛋白、前白蛋白及肺损伤积分是ARDS患者死亡预后的危险因素,白蛋白与前自蛋白的OR值分别为2．543和3．008。结论白蛋白与前白蛋白可用于预测ARDS患者的死亡预后。     

血清miR-133a在脓毒症并发ARDS中表达及预后的关系

目的分析血清微小核糖核酸(miR)-133a在脓毒症并发急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者中的表达及与预后的关系。 方法选取2019年6月至2021年5月我院收治的65例脓毒症患者,根据是否并发ARDS,分为并发ARDS 35例和无ARDS 30例。随访28 d,统计脓毒症并发ARDS者预后,检测患者入住ICU第1天、第2天、第3天血清miR-133a水平,比较存活者和死亡者临床特征,采用Logistic回归分析判定影响脓毒症并发ARDS预后的因素,采用受试者工作曲线(ROC)分析血清miR-133a水平预测脓毒症并发ARDS者预后的价值。 结果并发ARDS入住ICU第1天、第2天、第3天血清miR-133a水平均高于无ARDS者(P<0.05);随访28 d,脓毒症并发ARDS者病死率为40.00%;死亡者入住ICU第1天、第2天、第3天血清miR-133a水平均高于存活者(P<0.05);死亡者序贯器官衰竭(SOFA)评分、血管外肺水指数、第1天血清miR-133a水平与存活者比较,差异均有统计学意义(P<0.05);Logistic多因素回归分析显示SOFA评分、第1天血清miR-133a水平均是影响脓毒症并发ARDS者死亡的危险因素(P<0.05);ROC分析显示,第1天血清miR-133a水平预测脓毒症并发ARDS者死亡的最佳截断点为1.47,灵敏度为85.71%,特异度为90.48%,AUC为0.857。 结论脓毒症并发ARDS者血清miR-133a水平升高,血清miR-133a水平是影响脓毒症并发ARDS者死亡的危险因素,监测血清miR-133a水平变化,作为预测患者预后的指标。     

ARDS 患者中血清 microRNAs 生物标志物的筛选

目的：对 ARDS 患者血清 miRNAs 生物标志物进行筛选。方法选取我院 ICU 2013年6月至2015年6月接收的60例 ARDS 患者,同时选取我院体检的志愿者50名作为健康对照组,2组患者的年龄、性别差异无统计学意义。ARDS 患者血清 miRNAs 的表达图谱通过微阵列分析。微阵列数据通过实时定量 RT-PCR 进一步分析。结果本实验所提取的总 RNA 的 A260/A280和 A260/A230比例分别大于1.9和2.0,表明所提取的总 RNA 的质量是较好的。miRNAs 微阵列数据的结果表明：基于 SAM 分析有27种 miRNAs 的表达与健康对照组相比是显著性改变的(P <0.05),其中有20种 miRNAs 表达是上调的,有7种 miRNAs 表达是下调的。下调的 miRNAs 包括 miR-24、miR-26a、miR-126和 Let-7的家庭成员,上调的 miRNAs 包括 miR-99a、miR-127、miR-128b、miR-135b、miR-30a 和 miR-30b。最终挑选出来的 miRNAs 是经过 RT-PCR 验证的,miR-99a 和 miR-30b 被确认是 ARDS 患者血清中上调的 miRNAs,而 miR-126和 miR-26a 被确认是 ARDS 患者血清中下调的miRNAs。结论 miR-99a、miR-30b、miR-126和 miR-26a 这4个血清组合可能作为 ARDS 诊断潜在的生物标志物。     

Tumor necrosis factor levels in serum and bronchoalveolar lavage fluid of patients with the adult respiratory distress syndrome

Tumor necrosis factor (TNF) was measured antigenically and functionally in serum and bronchoalveolar lavage fluid (BAL) of patients with ARDS and those at high risk for ARDS. Of 22 patients with ARDS, 14 had sepsis or serious infection as the major clinical predisposition, and 10 of 20 high-risk patients had sepsis or serious infection. Mean levels of TNF in serum of patients with ARDS and high risk showed a trend toward elevation but were not significantly higher than mean serum levels in normal subjects. Mean levels of TNF in BAL of ARDS patients (242 +/- 126 pg/ml) were significantly higher than in normal subjects (9 +/- 5 pg/ml), p less than 0.05. Antigenic levels of TNF were undetectable in approximately half the patients with ARDS or the high-risk state. Levels of TNF in BAL appeared to be highest in the first day of ARDS. There appeared to be no relationship between levels of TNF in serum or BAL and subsequent mortality. However, serum levels of TNF were significantly higher in septic patients than in nonseptic patients, whereas this difference was not apparent in BAL. These results show that functional and antigenic elevations of TNF are present in BAL and perhaps in serum of patients with ARDS or with the high-risk state.     

Prone positioning in patients with acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure that is characterized by marked hypoxemia, bilateral infiltrates on chest radiograph, and no clinical evidence of left ventricular failure. Mechanical ventilation with positive end-expiratory pressure (PEEP) is a cornerstone therapy for ARDS patients. Because the fundamental aim of supportive treatment is to improve arterial oxygenation, several alternatives to mechanical ventilation with PEEP have been used. One of these alternative therapies is prone positioning, which has been used safely to improve oxygenation in many patients with ARDS. Despite encouraging results, however, the use of prone positioning is not widely accepted as an adjunct to therapy in hypoxemic patients because, aside from temporarily improving gas exchange, it does not seem to affect the outcome of these patients. This article reviews the rationale for using prone positioning in ARDS patients who require intubation and mechanical ventilation.     

Changes in intestinal microflora in rats with acute respiratory distress syndrome

AIM:To implement high-throughput 16S rDNA sequencing to study microbial diversity in the fecal matter of rats with acute lung injury/acute respiratory distress syndrome(ALI/ARDS).METHODS:Intratracheal instillation of lipopolysaccharide was used to induce ALI,and the pathological changes in the lungs and intestines were observed.D-lactate levels and diamine oxidase(DAO)activities were determined by enzymatic spectrophotometry.The fragments encompassing V4 16S rDNA hypervariable regions were PCR amplified from fecal samples,and the PCR products of V4 were sequenced by Illumina MiSeq.RESULTS:Increased D-lactate levels and DAO activities were observed in the model group(P<0.01).Sequencing results revealed the presence of 3780 and4142 species in the control and model groups,respectively.The percentage of shared species was 18.8419%.Compared with the control group,the model group had a higher diversity index and a lower number of species of Fusobacteria(at the phylum level),Helicobacter and Roseburia(at the genus level)(P<0.01).Differences in species diversity,structure,distribution and composition were found between the control group and early ARDS group.CONCLUSION:The detection of specific bacteria allows early detection and diagnosis of ALI/ARDS.     

Sepsis-induced acute respiratory distress syndrome with fatal outcome is associated to increased serum transforming growth factor beta-1 levels

BackgroundTGF-β1 is a promoter of pulmonary fibrosis in many chronic inflammatory diseases. TGF-β1 circulating levels in patients with sepsis-induced Acute Respiratory Distress Syndrome (ARDS) have not been established.MethodsIn this prospective pilot cohort study, serum bioactive TGF-β1 concentration, determined by sandwich ELISA, was analyzed in 52 patients who fulfilled criteria for septic shock at admission and on days 3 and 7.ResultsOf the 52 patients enrolled in the study, 46.1% fulfilled the criteria for ARDS on admission. At ICU admission, there were not statistical differences in TGF-β1 concentrations between septic shock patients with or without ARDS. After 7 days of follow-up in ICU, circulating TGF-β1 levels were significantly higher in patients with sepsis and ARDS than in those without ARDS [55.47 (35.04–79.48 pg/ml) versus 31.65 (22.89–45.63 pg/ml), respectively] (p = 0.002). Furthermore, in septic shock associated ARDS patients, TGF-β1 levels were significantly higher in nonsurvivors than in survivors [85.23 (78.19–96.30 pg/ml) versus 36.41 (30.21–55.47 pg/ml), respectively] (p = 0.006) on day 7 of ICU follow-up.ConclusionsIn patients with septic shock, persistent ARDS is accompanied with increased circulating TGF-β1 levels. Furthermore, ARDS patients with fatal outcome show higher TGF-β1 concentrations than survivors. These results suggest the relevance of TGF-β1 levels found in the pathogenesis of persistent sepsis-induced ARDS.     

Fluid management in patients with acute respiratory distress syndrome

In a recent review of the data for fluid strategies and ARDS, fluid restriction or diuretic use was graded as "reasonably justifiable by available scientific evidence" and as "strongly supported by expert critical care opinion". Until the ARDS Network trial is published, only general guidelines regarding fluid management with or without specific vascular filling pressures from a pulmonary artery catheter can be made. Ultimately, the rationale for restricting fluid is to reduce hydrostatic pressures as much as possible. It seems most reasonable to maintain the lowest PAOP in ARDS patients that still maintains adequate circulating blood volume, mean arterial perfusion pressures, and cardiac output to provide sufficient oxygen delivery. Other clinical variables such as central venous pressure, urinary output, acid-base status, and lactate, serum urea nitrogen, and serum creatinine levels may help in judging the adequacy of a patient's intravascular volume, especially if central vascular pressure measurements are not available. Measures to reduce total body water, including flood restriction and diuretic use, seem to be of some benefit. Vasopressor use is especially important when systemic perfusion pressures are inadequate to maintain organ blood flow but should not be used to create supranormal levels of oxygen delivery.