血浆YKL-40浓度对危重症患者并发腹腔间隙综合征的预测作用

目的:揭示危重症患者血浆YKL-40浓度的变化,探讨其对危重症患者并发腹腔间隙综合征的预测价值。方法:收集危重症患者和健康体检人群各98例。健康体检人群静脉血体检时获得,危重症患者静脉血在入院时获得。ELISA检测血浆YKL-40浓度。结果:危重症患者血浆YKL-40浓度(146.8±79.5)ng/ml显著高于健康体检者(39.4±12.5)ng/ml(t=8.749,P<0.01),与APACHEⅡ评分,呈显著正相关性(r=0.591,P<0.01)。28例(28.6%)并发腹腔间隙综合征。多因素分析显示,血浆YKL-40浓度(OR=1.492,95%CI=1.231～2.116,P<0.01)是危重症患者并发腹腔间隙综合征的独立危险因素。ROC曲线分析显示,血浆YKL-40浓度预测危重症患者并发腹腔间隙综合征有显著预测价值(曲线下面积=0.842,95%CI=0.791～0.914,P<0.001),且判定血浆YKL-40浓度>172.4 ng/ml,对预测并发腹腔间隙综合征有82.1%的灵敏度和78.6%的特异度。结论:危重症患者并发腹腔间隙综合征后,血浆YKL-40浓度显著升高,临床检测YKL-40作为有预报价值的标志物,有助于早期判断腹腔间隙综合征的发生。

The Predictive Effect of Plasma YKL-40 Concentration for Occurrence of Abdominal Compartment Syndrome in Patients with Critical Illness

Objective To observe the change of plasma YKL-40 level in patients with critical illness and its correlation with occurrence of abdominal compartment syndrome was evaluated.Methods Ninety-eight consecutive patients with critical illness and 98 ageand sex-matched healthy controls were enrolled into this study.Plasma samples were obtained on entry in healthy controls,as well as on admission in the patients.Its concentration was measured by ELISA.Results The plasma YKL-40 level(146.8±79.5ng/ml) in patients was significantly higher than that(39.4±12.5 ng/ml) in healthy controls(t =8.749,P <0.01),and was positively associated with APACHEIIscore(r =0.591,.P<0.01).28 patients(28.6%)were complicated with abdominal compartment syndrome.On a multivariate logistic regression,plasma YKL-40 level(odds ratio = 1.492,95%C.I.= 1.231～2.116,P < 0.01) was an independent variable predicting occurrence of abdominal compartment syndrome.A receiver operating characteristic curve identified that a plasma YKL-40 level > 172.4 ng/ml predicted occurrence of abdominal compartment syndrome with 82.1 sensitivity and 78.6%specificity separately (Area under curve = 0.842,95%CI = 0.791～0.914,P < 0.001).Conclusion Increased plasma YKL40 level is found after abdominal compartment syndrome in patients with critical illness,and identified as a predictive marker of occurrence of such syndrome.