血清SP-D及CRP水平在ARDS患者病情严重程度中的诊断价值

目的探讨血清肺表面活性蛋白D(SP-D)及C反应蛋白(CRP)用于急性呼吸窘迫综合征(ARDS)患者诊断的临床价值。方法选择2017年1月至2019年12月住院治疗的ARDS患者82例为ARDS组,同时选择健康对照者60例为对照组。记录患者一般情况及常规实验室指标,进行动脉血气分析,检测血清SP-D及CRP。使用受试者工作特征曲线(ROC曲线)评估SP-D及CRP用于ARDS诊断的临床价值。结果与对照组相比,ARDS组血清SP-D及CRP水平更高,差异有统计学意义(P<0.05)。不同严重程度ARDS患者的SP-D水平由低至高分别为:轻度ARDS(19.23±7.06)ng/mL]、中度ARDS(23.48±9.09)ng/mL]及重度ARDS(29.91±7.10)ng/mL];CRP水平由低至高分别为:轻度ARDS(247.05±130.18)mg/L]、中度ARDS(298.94±168.11)mg/L]、重度ARDS(491.45±210.26)mg/L)]。ARDS组患者中,SP-D及CRP均与乳酸、ARDS严重程度、急性生理与慢性健康评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分)呈正相关(P<0.05),与动脉血氧分压(PaO₂)/吸入氧浓度(FiO₂)呈负相关(P<0.05)。SP-D及CRP单独检测诊断ADRS的曲线下面积(AUC)分别为0.798及0.765,二者联合检测的AUC为0.860。SP-D及CRP单独检测用于鉴别诊断中重度ARDS与轻度ARDS的AUC分别为0.737及0.704,二者联合检测的AUC为0.792。结论血清SP-D及CRP的检测对ARDS病情严重程度的诊断具有较高的价值,且联合检测的价值优于单独检测。

Diagnostic value of the levels of serum SP-D and CRP in patients with the severity of ARDS

Objective To investigate the diagnostic value of surfactant protein-D(SP-D)and C-reactive protein(CRP)in patients with acute respiratory distress syndrome(ARDS).Methods A total of 82 patients with ARDS(ARDS group)from January 2017 to December 2019 were enrolled,and 60 health people were enrolled as control(control group).The general conditions and laboratory parameters were recorded,arterial blood gas was tested,and serum SP-D and CRP levels were detected.ROC curve was used to evaluate the clinical value of SP-D and CRP for diagnosis of ARDS.Results Compared with control group,serum SP-D and CRP were significantly higher in ARDS group(P<0.05).SP-D levels in different ARDS patients from low to high were mild ARDS(19.23±7.06)ng/mL],moderate ARDS(23.48±9.09)ng/mL]and severe ARDS(491.45±210.26)mg/L)].CRP levels from low to high were mild ARDS(247.05±130.18)mg/L],moderate ARDS(298.94±168.11)mg/L],severe ARDS(491.45±210.26)mg/L)].In patients with ARDS group,SP-D and CRP were both positively correlated with lactic acid,severity,ARDS grade,APACHEⅡscore,SOFA score(P<0.05),and negatively correlated with PaO₂/FiO₂(P<0.05).When used to distinguish ARDS from control group,the area under the curve(AUC)of SP-D and CRP was 0.798 and 0.765 respectively,and that of SP-D combined with CRP was 0.860.When used to distinguish severe/moderate ARDS from mild ARDS,the AUC of SP-D and CRP were 0.737 and 0.704,and that of SP-D combined with CRP was 0.792.Conclusion The detection of serum SP-D and CRP has higher value in diagnosis of the severity of ARDS,and the value of combined detection of SP-D and CRP is much better than that of single index detection.