VEGF对闭合性胸外伤合并ARDS发生和病情预测中的临床价值
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摘要
目的探讨血管内皮生长因子(VEGF)在闭合性胸外伤合并急性呼吸窘迫综合征(ARDS)发生和病情预测中的价值。方法选取2017年1月-2018年6月我院收治的80例闭合性胸外伤合并ARDS患者,将其作为观察组,并随机选取同期闭合性胸外伤未发生ARDS患者80例作为对照组。检测患者的VEGF、TNF-α、CRP水平,并采用APACHEⅡ以及SOFA评分进行病情评估,采用Spearman检验分析各项指标与病情的相关性。采用ROC曲线分析各个指标的敏感性及特异性。结果入院时,两组患者的各项指标比较无显著差异(P>0.05)。入院后,观察组患者不同时间段的VEGF、TNF-α、CRP、APACHEⅡ以及SOFA评分均明显高于对照组(P<0.05)。VEGF、TNF-α和CRP水平的预测值分别为143.14mg/mL、43.84μg/mL和28.29mg/mL。VEGF水平的灵敏度、特异性、阳性预测值和阴性预测值均明显高于TNF-α和CRP(P<0.05)。VEGF、TNF-α、CRP与APACHEⅡ评分和SOFA评分均呈正相关。结论 VEGF是评估闭合性胸外伤合并ARDS发生和病情预测的可靠指标,且敏感性及特异性均较高,有望成为新的独立评估指标,较TNF-α及CRP更有临床意义。
Objective To explore the value of vascular endothelial growth factor(VEGF)in the occurrence and prognosis of closed thoracic trauma complicated with acute respiratory distress syndrome(ARDS).Methods Eighty patients with closed thoracic trauma complicated with ARDS in our hospital were selected as observation group from January 2017 to June 2018,and 80 patients with closed thoracic trauma without ARDS were randomly selected as control group in the same period.The levels of vascular endothelial growth factor(VEGF),TNF-a and CRP were measured.APACHE II and SOFA scores were used to evaluate the condition.Spearman test was used to analyze the correlation between the indicators and the condition.The sensitivity and specificity of each index were analyzed by ROC curve.Results There was no significant difference in each index between the two groups at admission(P>0.05).the scores of vascular endothelial growth factor,TNF-a,CRP,APACHE II and SOFA in the observation group were significantly higher than those in the control group after admission(P<0.05).The predicted levels of VEGF were 143.14 mg/mL,the predicted levels of TNF-α43.84μg/mL,the predicted levels of CRP were 28.29 mg/mL.The sensitivity,specificity,positive predictive value and negative predictive value of the level of VEGF were significantly higher than those of TNF-αand CRP(P<0.05).VEGF,TNF-a,CRP were positively correlated with APACHE II score and SOFA score.Conclusion VEGF is a reliable index for evaluating the occurrence and prognosis of ARDS in closed thoracic trauma with high sensitivity and specificity.It is expected to become a new independent evaluation index,which has more clinical significance than TNF-alpha and CRP.
Objective To explore the value of vascular endothelial growth factor(VEGF)in the occurrence and prognosis of closed thoracic trauma complicated with acute respiratory distress syndrome(ARDS).Methods Eighty patients with closed thoracic trauma complicated with ARDS in our hospital were selected as observation group from January 2017 to June 2018,and 80 patients with closed thoracic trauma without ARDS were randomly selected as control group in the same period.The levels of vascular endothelial growth factor(VEGF),TNF-a and CRP were measured.APACHE II and SOFA scores were used to evaluate the condition.Spearman test was used to analyze the correlation between the indicators and the condition.The sensitivity and specificity of each index were analyzed by ROC curve.Results There was no significant difference in each index between the two groups at admission(P>0.05).the scores of vascular endothelial growth factor,TNF-a,CRP,APACHE II and SOFA in the observation group were significantly higher than those in the control group after admission(P<0.05).The predicted levels of VEGF were 143.14 mg/mL,the predicted levels of TNF-α43.84μg/mL,the predicted levels of CRP were 28.29 mg/mL.The sensitivity,specificity,positive predictive value and negative predictive value of the level of VEGF were significantly higher than those of TNF-αand CRP(P<0.05).VEGF,TNF-a,CRP were positively correlated with APACHE II score and SOFA score.Conclusion VEGF is a reliable index for evaluating the occurrence and prognosis of ARDS in closed thoracic trauma with high sensitivity and specificity.It is expected to become a new independent evaluation index,which has more clinical significance than TNF-alpha and CRP.
引文
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[9]马强,吴占庆,杨培雄,等.急性呼吸窘迫综合征患者血清中血管内皮生长因子肿瘤坏死因子-α和降钙素原的表达[J].中国老年学杂志,2015,35(10):5842.
[10]梅春霞,刘娟,徐智.APACHEⅡ评分和降钙素原对肺部感染预后的预测作用[J].第三军医大学学报,2014,36(8):802.
[11]江浩,郑贸根,朱超男,等.APACHEⅡ、ISS、SOFA评分对创伤继发ARDS严重程度及预后的预测价值比较[J].临床肺科杂志,2018,23(11):2074.
[12]何荣香,俞丹,何英,等.CPIS评分联合CURB-65评分系统在医院获得性肺炎评价中的作用及价值研究[J].中华医院感染学杂志,2019,29(2):300.
[2]李艳秀,左祥荣,曹权.PCT联合APACHEⅡ评分对ICU肺部感染合并脓毒症的评估[J].南京医科大学学报(自然科学版),2018,38(12):1725.
[3]耿新峰.急性呼吸窘迫综合征患者血清生物标志物水平的临床意义[J].中国卫生检验杂志,2017,27(19):2792.
[4]纪明锁,任新生,徐杰,等.患者血清VEGF、PCT以及TNF-α的表达及临床意义[J].中国实验诊断学,2016,20(9):1541.
[5]Ferguson ND,Fan E,Camporota L,et al.The Berlin definition of ARDS:an expanded rationale,justification,and supplementary material[J].Intensive Care Med,2012,38(10):1573.
[6]陆志斌,周存荣,占根生,等.sTREM-1在钝性胸部外伤及合并肺挫伤中的动态变化及临床意义[J].山西医科大学学报,2015,46(7):675.
[7]邢佳丽,陈建荣,沈君华,等.急性呼吸窘迫综合征患者呼出气冷凝液中VEGF-A及8-isoPG检测的临床意义[J].临床急诊杂志,2017,18(1):26.
[8]袁超,金娜.APACHEⅡ评分和血管性血友病因子对急性呼吸窘迫综合征肺损伤程度及预后的评估价值[J].中国呼吸与危重监护杂志,2016,15(2):142.
[9]马强,吴占庆,杨培雄,等.急性呼吸窘迫综合征患者血清中血管内皮生长因子肿瘤坏死因子-α和降钙素原的表达[J].中国老年学杂志,2015,35(10):5842.
[10]梅春霞,刘娟,徐智.APACHEⅡ评分和降钙素原对肺部感染预后的预测作用[J].第三军医大学学报,2014,36(8):802.
[11]江浩,郑贸根,朱超男,等.APACHEⅡ、ISS、SOFA评分对创伤继发ARDS严重程度及预后的预测价值比较[J].临床肺科杂志,2018,23(11):2074.
[12]何荣香,俞丹,何英,等.CPIS评分联合CURB-65评分系统在医院获得性肺炎评价中的作用及价值研究[J].中华医院感染学杂志,2019,29(2):300.