血清血管紧张素Ⅰ与血管紧张素1-7比值对脓毒症相关急性呼吸窘迫综合征患者预后的预测价值

冯长福; 邝顺灵; 甘惠玲

doi:10.13201/j.issn.1009-5918.2021.09.001

血清血管紧张素Ⅰ与血管紧张素1-7比值对脓毒症相关急性呼吸窘迫综合征患者预后的预测价值

- 海南医学院第二附属医院重症医学科(海口,570311)
基金项目:
海南省卫生健康行业科研项目(No:1801032054A2006)

详细信息

通讯作者: 甘惠玲,E-mail:fcffxh@163.com

中图分类号: R631.2

收稿日期: 2021-06-11

Serum angiotensinⅠ to angiotensin 1-7 ratio for predicting prognosis of patients with sepsis-related acute respiratory distress syndrome

- Department of Intensive Care Unit, the Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China

More Information

Corresponding author: GAN Huiling, E-mail: fcffxh@163.com

Received Date: 11 June 2021

摘要

摘要: 目的:探讨血清血管紧张素(Ang)Ⅰ与Ang1-7比值对脓毒症相关急性呼吸窘迫综合征(ARDS)患者预后的预测价值。方法:回顾性分析88例脓毒症相关ARDS患者的相关资料,根据28 d死亡结局分为存活组(n=52)和死亡组(n=36),比较两组患者在基本情况、入院24 h脓毒症相关器官衰竭估计(SOFA)评分、血气分析、血小板、血清白蛋白、总胆红素、血肌酐、血乳酸、AngⅠ、Ang1-7及AngⅠ/Ang1-7比值等方面的差异。应用二元Logistic回归分析探讨脓毒症相关ARDS患者28 d死亡的影响因素;绘制受试者工作特征(ROC)曲线,评价各指标对脓毒症相关ARDS患者28 d死亡的预测价值;采用Spearson相关分析探讨脓毒症相关ARDS患者AngⅠ/Ang1-7比值与SOFA评分及氧合指数的相关性。结果:死亡组患者SOFA评分、AngⅠ、AngⅠ/Ang1-7比值、血乳酸、血肌酐及总胆红素水平明显高于存活组,而Ang1-7、氧合指数、碳酸氢根、pH及血小板水平明显低于存活组,差异具有统计学意义(P<0.05)。二元Logistic回归分析结果显示,SOFA评分(OR=1.371,95%CI:1.042~1.804,P=0.024)、AngⅠ(OR=1.502,95%CI:1.063~2.123,P=0.021)、Ang1-7(OR=0.196,95%CI:0.050~0.770,P=0.020)及AngⅠ/Ang1-7比值(OR=1.641,95%CI:1.090~2.470,P=0.018)为ARDS患者28 d死亡的独立影响因素。AngⅠ、Ang1-7、AngⅠ/Ang1-7比值及SOFA评分预测脓毒症相关ARDS患者28 d死亡的ROC曲线下面积(AUC)分别为0.804(95%CI:0.706~0.881)、0.625(95%CI:0.515~0.726)、0.926(95%CI:0.850~0.971)、0.782(95%CI:0.681~0.863)。AngⅠ/Ang1-7比值预测脓毒症相关ARDS患者28 d死亡的AUC明显大于AngⅠ、Ang1-7及SOFA评分预测脓毒症相关ARDS患者28 d死亡的AUC(Z=2.322,P=0.020;Z=5.266,P<0.001;Z=2.564,P=0.010)。当AngⅠ/Ang1-7比值的最佳临界值为1.99时,预测脓毒症相关ARDS患者28 d死亡的敏感度为86.1%,特异度为92.3%。Spearson相关分析结果显示,脓毒症相关ARDS患者AngⅠ/Ang1-7比值与SOFA评分呈明显正相关(r=0.478,P<0.001),而与氧合指数呈明显负相关(r=-0.245,P=0.021)。结论:血清AngⅠ/Ang1-7比值与脓毒症相关ARDS患者的病情严重程度及预后密切相关,为28 d死亡的独立危险因素,可作为评价脓毒症相关ARDS患者预后的较好指标。
- 血管紧张素Ⅰ /
- 血管紧张素1-7 /
- 血管紧张素Ⅰ/血管紧张素1-7比值 /
- 急性呼吸窘迫综合征 /
- 脓毒症 /
- 预后
Abstract: Objective: To explore the serum angiotensin(Ang)Ⅰ to Ang 1-7 ratio for predicting prognosis of patients with sepsis-related acute respiratory distress syndrome(ARDS).Methods: A total of 88 patients with sepsis-related ARDS were involved in the retrospective study. They were divided into survivor group(n=52) and death group(n=36) according to 28-day outcome. Baseline indexes, Sepsis-related Organ Failure Assessment(SOFA) score, blood gas analysis, platelet(PLT), albumin, total bilirubin, serum creatinine(Scr), lactic acid(Lac), AngⅠ, Ang 1-7 and AngⅠ/Ang 1-7 ratio were recorded within 24 h after admission, and the differences of above indicators were analyzed. The influencing factors for 28-day mortality in patients with sepsis-related ARDS were explored by binary Logistic regression analysis. The receiver operating characteristic(ROC) curves were drawn to evaluate the predictive value of each marker for 28-day mortality in patients with sepsis-related ARDS. And the correlations between AngⅠ/Ang 1-7 ratio with SOFA score and oxygenation index in patients with sepsis-related ARDS were explored by Spearson correlation analysis.Results: The levels of SOFA score, AngⅠ, AngⅠ/Ang1-7 ratio, Lac, Scr and total bilirubin in the death group were higher than those in survivor group(P<0.05). while the levels of Ang1-7, oxygenation index, HCO₃^-, pH and PLT in the death group were lower than those in survivor group(P<0.05). Binary Logistic regression analysis showed that SOFA score(OR=1.371, 95%CI: 1.042-1.804, P=0.024), AngⅠ(OR=1.502, 95%CI: 1.063-2.123, P=0.021), Ang1-7(OR=0.196, 95%CI: 0.050-0.770, P=0.020) and AngⅠ/Ang1-7 ratio(OR=1.641, 95%CI: 1.090-2.470, P=0.018) were independent influencing factors for 28-day mortality in patients with sepsis-related ARDS(P<0.05). The area under ROC curve(AUC) of AngⅠ, Ang1-7, AngⅠ/Ang1-7 ratio and SOFA score for predicting 28-day mortality in patients with sepsis-related ARDS was 0.804(95%CI: 0.706-0.881), 0.625(95%CI: 0.515-0.726), 0.926(95%CI: 0.850-0.971), 0.782(95%CI: 0.681-0.863), respectively. The AUC of AngⅠ/Ang1-7 ratio for predicting 28-day mortality in patients with sepsis-related ARDS was significantly greater than that of AngⅠ, Ang1-7 and SOFA score(Z=2.322, P=0.020; Z=5.266, P<0.001; Z=2.564, P=0.010). The optimal cutoff value of the AngⅠ/Ang1-7 ratio was 1.99, which displayed a sensitivity of 86.1% and a specificity of 92.3% for the prediction of 28-day mortality in patients with sepsis-related ARDS. Spearson correlation analysis showed that the AngⅠ/Ang1-7 ratio was positively correlated with the SOFA score(r=0.478, P<0.001), and was negatively correlated with the oxygenation index(r=-0.245, P=0.021).Conclusion: The level of serum AngⅠ/Ang1-7 ratio was closely related to the illness severity and prognosis in patients with sepsis-related ARDS, and it was an independent risk factors for 28-day mortality. AngⅠ/Ang1-7 ratio can be a good indicator for evaluating the prognosis in patients with sepsis-related ARDS.
- angiotensin Ⅰ /
- angiotensin 1-7 /
- angiotensin Ⅰ to angiotensin 1-7 ratio /
- acute respiratory distress syndrome /
- sepsis /
- prognosis

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