急性呼吸窘迫综合征患者血清诱骗受体3和白细胞介素9水平变化及临床意义

目的探讨血清诱骗受体3(decoy receptor 3,DcR3)和白细胞介素9(interleukin-9,IL-9)在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中表达情况及临床意义。方法86例ARDS为ARDS组,43例体检健康者为对照组。ARDS组根据氧合指数(oxygenation index,OI)分为轻度组(OI>26.6~39.9 kPa)22例、中度组(OI>13.3~26.6 kPa)45例和重度组(OI≤13.3 kPa)19例,根据患者28 d生存情况分为生存组40例和死亡组46例。检测各组血清DcR3、IL-9和降钙素原(procalcitonin,PCT)水平,绘制ROC曲线,评估血清DcR3、IL-9和PCT水平预测ARDS患者预后的临床价值;采用Kaplan-Meier法绘制生存曲线,采用log-rank检验比较不同DcR3、IL-9和PCT水平ARDS患者28 d的存活率。结果ARDS组血清DcR3[(2.93±1.01)μg/L]、IL-9[(4.36±1.17)ng/L]和PCT[(1.62±0.53)μg/L]水平明显高于对照组[(0.49±0.18)μg/L、(2.01±0.73)ng/L、(0.38±0.12)μg/L](P<0.05);轻度组、中度组和重度组血清DcR3、IL-9和PCT水平均依次升高(P<0.05);生存组血清DcR3[(2.11±1.13)μg/L]、IL-9[(3.81±1.20)ng/L]和PCT[(1.41±0.49)μg/L]水平明显低于死亡组[(3.64±1.62)μg/L、(4.84±1.33)ng/L、(1.80±0.57)μg/L](P<0.05);DcR3、IL-9和PCT的最佳截断值分别为2.98μg/L、4.02 ng/L、1.59μg/L时,预测ARDS患者预后的AUC分别为0.845(95%CI:0.760~0.929)、0.821(95%CI:0.735~0.906)、0.763(95%CI:0.661~0.864),灵敏度分别为0.761、0.739、0.713,特异度分别为0.856、0.807、0.725;DcR3≥2.98μg/L、IL-9≥4.02 ng/L和PCT≥1.59μg/L时,ARDS患者28 d存活率(34.00%、37.25%、38.78%)较DcR3<2.98μg/L、IL-9<4.02 ng/L和PCT<1.59μg/L者(63.89%、60.00%、56.76%)明显降低(P<0.001)。结论ARDS患者血清DcR3、IL-9和PCT水平明显上升,可作为评价ADRS患者病情严重程度和预后的指标,DcR3和IL-9的临床价值优于PCT。

Changes and clinical significances of serum levels of decoy receptor 3 and interleukin-9 in patients with acute respiratory distress syndrome

Objective To investigate the changes and clinical significances of serum levels of decoy receptor 3(DcR3)and interleukin-9(IL-9)in patients with acute respiratory distress syndrome(ARDS).Methods Eighty-six patients with ARDS(ARDS group)were divided into 22 patients with oxygenation index(OI)>26.6-39.9 kPa(mild group),45 patients with OI>13.3-26.6 kPa(moderate group)and 19 patients with OI≤13.3 kPa(severe group),and 43 another healthy volunteers were as controls(control group).And ARDS group was redivided into survival group(n=40)and death group(n=46)according to the 28-day survival.The serum levels of DcR3,IL-9 and procalcitonin(PCT)were detected in each group.ROC was used to evaluate the clinical values of serum DcR3,IL-9 and PCT levels to predicting the prognosis of patients with ARDS.The survival curve was drawn by Kaplan-Meier method,and log-rank test was used to compare the 28-day survival rates of ARDS patients with different levels of DcR3,IL-9 and PCT.Results The serum levels of DcR3,IL-9 and PCT were significantly higher in ARD group((2.93±1.01)μg/L,(4.36±1.17)ng/L,(1.62±0.53)μg/L)than those in control group((0.49±0.18)μg/L,(2.01±0.73)ng/L,(0.38±0.12)μg/L)(P<0.05),and increased gradually in turn in mild,moderate and severe groups(P<0.05).The serum levels of DcR3,IL-9 and PCT were significantly lower in survival group((2.11±1.13)μg/L,(3.81±1.20)ng/L,(1.41±0.49)μg/L)than those in death group((3.64±1.62)μg/L,(4.84±1.33)ng/L,(1.80±0.57)μg/L)(P<0.05).When the optimal cut-off values of DcR3,IL-9 and PCT were 2.98μg/L,4.02 ng/L and 1.59μg/L,the AUCs for predicting the prognosis of ARDS patients were 0.845(95%CI:0.760-0.929),0.821(95%CI:0.735-0.906),and 0.763(95%CI:0.661-0.864),with sensitivities of 0.761,0.739 and 0.713,and specificities of 0.856,0.807 and 0.725,respectively.The 28-day survival rates of ARDS patients with DcR3≥2.98μg/L,IL-9≥4.02μg/L and PCT≥1.59μg/L(34.00%,37.25%,38.78%)were significantly lower than those of patients with DcR3<2.98μg/L,IL-9<4.02 ng/L and PCT<1.59μg/L(63.89%,60.00%,56.76%)(P<0.001).Conclusion The serum levels of DcR3,IL-9 and PCT in patients with ARDS increase significantly,which could be used as indicators to evaluate the severity and prognosis of ADRS.The clinical value of DcR3 and L-9 is superior to PCT.