老年ARDS 患者血清FGF-21，GDF-15 及PTX-3 表达水平及其与病情评估和预后的相关性研究

目的 探讨血清成纤维细胞生长因子21（fibroblast growth factor 21,FGF-21）、生长分化因子15（growthdifferentiation factor 15 ,GDF-15）及正五聚蛋白3（pentamerin 3,PTX-3） 水平对老年急性呼吸窘迫综合征（acuterespiratory distress syndrome，ARDS）患者病情评估及预后预测的价值。方法 选取2019 年1 月～ 2021 年12 月儋州市人民医院收治的125 例老年ARDS 患者，根据氧合指数（oxygenation index ,OI）将老年ARDS 患者分为轻度组(n=32)、中度组(n=53) 和重度组(n=40)，根据入重症监护室（intensive care unit，ICU）30 天内的生存情况将老年ARDS 患者分为存活组(n=76) 和死亡组(n=49)。检测老年ARDS 患者发病当天血清FGF-21，GDF-15 及PTX-3 水平。应用多因素Logistic 回归分析影响老年ARDS 患者死亡的危险因素，绘制ROC 曲线分析血清FGF-21，GDF-15 及PTX-3 水平对老年ARDS 患者预后预测的价值。相关性分析采用Pearson 相关。结果 死亡组血清FGF-21（3 268.37±456.27 pg/ml），GDF-15（3 605.20±419.35 pg/ml） 及PTX-3（27.15±8.72ng/ml） 水平均明显高于存活组（950.24±130.28pg/ml，1 468.15±247.30 pg/ml，13.40±4.16 ng/ml），差异有统计学意义（t =17.361, 16.240，14.802，均P ＜ 0.001）。重度组血清FGF-21（3 709.24±524.17 pg/ml），GDF-15（4 150.83±507.42 pg/ml）及PTX-3（31.28±10.26 ng/ml）水平均明显高于中度组（2 587.60±347.25 pg/ml，2 889.25±385.26 pg/ml，19.45±5.83 ng/ml）和轻度组（621.38±103.14 pg/ml，1 007.36±194.12 pg/ml，11.27±2.90 ng/ml），差异有统计学意义（F =20.153, 18.216, 17.615，均P ＜ 0.001）。多因素Logistic 回归分析显示，OI 低（OR=2.375, 95%CI:1.502~5.113），APACHE Ⅱ评分(OR=2.803, 95%CI:1.985~6.926)，SOFA 评分(OR=1.716, 95%CI:1.208~3.412)，FGF-21(OR=3.205, 95% CI:2.647~9.683)，GDF-15(OR=2.490, 95%CI:1.712~5.770) 及PTX-3(OR=3.104, 95%CI:2.573~9.184) 水平升高是影响ARDS 患者死亡的危险因素（均P ＜ 0.05）。ROC 曲线显示，FGF-21，GDF-15 及PTX-3 三项联合预测老年ARDS 患者死亡的AUC 最大（0.957，95%CI:0.897 ～ 0.998）。相关分析显示，ARDS 死亡患者血清FGF-21 水平与GDF-15，PTX-3 均呈正相关（r=0.842, 0.870, 均P ＜ 0.001）。结论 血清FGF-21，GDF-15 及PTX-3 水平升高与老年ARDS 患者病情较重和死亡有关，三项联合检测能较好地预测老年ARDS 患者的预后。

Expression Levels of Serum FGF-21, GDF-15 and PTX-3 in Elderly Patients with ARDS and Their Correlation with Disease Evaluation and Prognosis

Objective To investigate the value of levels of serum fibroblast growth factor-21 (FGF-21), growth differentiation factor-15 (GDF-15) and N-pentamerin 3 (PTX-3) in evaluating the condition and predicting the prognosis of elderly patients with acute respiratory distress syndrome (ARDS). Methods 125 elderly patients with ARDS treated in Danzhou People’s Hospital from January 2019 to December 2021 were selected. According to the oxygenation index (OI), the elderly patients with ARDS were divided into 32 mild groups, 53 moderate groups and 40 severe groups. According to the survival situation within 30 days after entering the intensive care unit, the elderly patients with ARDS were divided into 76 survival group and 49 death group. The levels of serum FGF-21, GDF-15 and PTX-3 in elderly patients with ARDS were detected on the day of onset. Multivariate logistic regression was used to analyze the risk factors of death in elderly patients with ARDS, and ROC curve was drawn to analyze the value of serum FGF-21, GDF-15 and PTX-3 levels in predicting the prognosis of elderly patients with ARDS. Pearson correlation was used for correlation analysis. Results The levels of serum FGF-21（3 268.37±456.27 pg/ml）， GDF-15（3 605.20±419.35 pg/ml）and PTX-3（27.15±8.72ng/ml）in the death group were significantly higher than those in the survival group，the differences were statistically significant（t =17.361，16.240，14.802， all P ＜ 0.001）. The levels of serum FGF-21（3 709.24±524.17 pg/ml），GDF-15（4 150.83±507.42 pg/ml）and PTX-3（31.28±10.26 ng/ml） in severe group were significantly higher than those in moderate group（2 587.60±347.25 pg/ml，2 889.25±385.26 pg/ml， 19.45±5.83 ng/ml）and mild group（621.38±103.14 pg/ml，1 007.36±194.12 pg/ml，11.27±2.90 ng/ml），the differences were statistically significant（F =20.153,18.2165,17.615，all P ＜ 0.001）. Multivariate logistic regression analysis showed that low OI（OR=2.375,95%CI:1.502~5.113）, Apache Ⅱ score(OR=2.803, 95% CI:1.985~6.926), SOFA score(OR=1.716, 95%CI:1.208~3.412), elevated levels of FGF-21(OR=3.205, 95% CI:2.647~9.683), GDF-15(OR=2.490, 95%CI:1.712~5.770) and PTX-3(OR=3.104, 95%CI:2.573~9.184) were the risk factors of death in patients with ARDS (all P<0.05). ROC curve showed that the combination of FGF-21, GDF-15 and PTX-3 had the highest AUC in predicting death of elderly patients with ARDS (0.957, 95%CI: 0.897 ～ 0.998). Correlation analysis showed that the level of serum FGF-21 in death patients with ARDS were positively correlated with GDF-15 and PTX-3 (r=0.842, 0.870, all P ＜ 0.001). Conclusion The increase of serum FGF- 21, GDF-15 and PTX-3 levels is related to the severity and death of elderly patients with ARDS, and the combination of the three can better predict the prognosis of elderly patients with ARDS.