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    尿I-FABP在成人重症肺炎所致ARDS临床诊断和死亡率预测的应用价值

    Application value of urinary I-FABP in the clinical diagnosis and mortality prediction of ARDS caused by severe pneumonia in adults

      摘要
    • 摘要: 目的：探讨尿肠型脂肪酸结合蛋白（I-FABP）在成人重症肺炎所致急性呼吸窘迫综合征（ARDS）临床诊断和死亡率预测中的应用价值。方法：收集2017年9月至2021年12月我院收治的197例重症肺炎患者作为研究对象，其中97例并发ARDS者纳入ARDS组，100例无ARDS者进展纳入非ARDS组。另根据28 d院内存活情况将ARDS组患者分为死亡亚组和存活亚组。采用酶联免疫吸附试验测定尿I-FABP水平。结果：ARDS组患者尿I-FABP水平高于非ARDS组（P＜0.001）。尿I-FABP水平预测重症肺炎患者发生ARDS的受试者工作特征（ROC）曲线下面积（AUC）为0.763（95%CI：0.697～0.830）。死亡亚组患者尿I-FABP水平高于存活亚组（P＜0.001）。尿I-FABP水平升高与基线急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）、序贯器官衰竭估计评分（SOFA）及存活者重症监护病房住院时间显著相关（P＜0.05）。尿I-FABP水平、基线APACHEⅡ和SOFA评分是重症肺炎所致ARDS患者28 d院内死亡的独立危险因素（P＜0.05）。ROC曲线分析结果显示，尿I-FABP水平预测ARDS患者28 d 院内死亡的AUC 为0.879（95%CI：0.812～0.947），联合APACHEⅡ或SOFA 的AUC 值大于二者单独预测的AUC 值（P＜0.05）。结论：重症肺炎所致的ARDS患者尿I-FABP水平普遍升高，I-FABP有望成为ARDS临床诊断以及28 d院内死亡率预测的标志物。

       

      Abstract: Objective: To investigate the value of urinary intestinal-fatty acid binding protein (I-FABP) in the clinical diagnosis and mortality prediction of acute respiratory distress syndrome (ARDS) caused by severe pneumonia in adults.Methods: A total of 197 patients with severe pneumonia admitted to our hospital from September 2017 to December 2021 were selected as the study subjects.Among them, 97 patients complicated with ARDS were included in the ARDS group, and 100 patients without ARDS progression were included in the non-ARDS group.In addition, the ARDS patients were divided into death subgroup and survival subgroup according to the survival in hospital for 28 days.The level of serum I-FABP was determined by enzyme-linked immunosorbent assay.Results: The level of urinary I-FABP in ARDS group was higher than that in non-ARDS group (P＜ 0.001).The area under receiver operating characteristic (ROC) curve (AUC) of urinary I-FABP level for predicting ARDS in severe pneumonia patients was 0.763 (95% CI: 0.697-0.830).The level of urinary I-FABP in the death subgroup was higher than that in the survival subgroup (P＜ 0.001).The increase of urinary I-FABP level was correlated with the baseline Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA) and the length of stay in intensive care unit of the survivors (P＜ 0.05).Urinary I-FABP level, baseline APACHE Ⅱand SOFA score were independent risk factors for 28 d in-hospital death in patients with ARDS caused by severe pneumonia (P＜ 0.05).ROC curve analysis showed that the AUC of 28 d in-hospital death in ARDS patients predicted by urinary I-FABP level was 0.879 (95% CI: 0.812-0.947), and the AUC value of urinary I-FABP combined with APACHE Ⅱor SOFA was greater than that predicted by the two alone (P＜ 0.05).Conclusion: The level of urinary I-FABP in patients with ARDS caused by severe pneumonia generally increases, and I-FABP is expected to become a reliable marker for the clinical diagnosis of ARDS and the prediction of 28 d in-hospital mortality.

       

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