摘要目的:探讨Clara细胞分泌蛋白16（CC16）及可溶性晚期糖基化终产物受体（sRAGE）联合检测对急性呼吸窘迫综合征（ARDS）诊断及预后评估的临床意义。方法:选择2019年7月至2020年9月入住天津医科大学朱宪彝纪念医院重症监护病房（ICU）的100例ARDS患者作为ARDS组，并选择同期入住ICU的100例非ARDS患者作为对照。收集患者的一般资料、生命体征、血气分析、血清CC16和sRAGE水平、机械通气时间、ICU住院时间及患者住院期间预后。绘制受试者工作特征曲线（ROC曲线），并计算ROC曲线下面积（AUC），评价CC16和sRAGE单独或联合检测对ARDS诊断及预后判断的临床价值。结果:ARDS组患者机械通气时间较非ARDS组更长（d：15.44±3.04比12.61±3.73， P<0.01），住院病死率也更高（38.0%比9.0%， P<0.01）；但两组性别、年龄、体重指数（BMI）、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）和ICU住院时间差异均无统计学意义。ARDS患者住院期间存活62例，死亡38例。死亡组患者APACHEⅡ评分较存活组更高（分：23.55±2.83比19.40±4.10， P<0.01）；两组年龄、BMI、氧合指数、平均动脉压、机械通气时间和ICU住院时间差异无统计学意义。ARDS组患者血清CC16和sRAGE水平均明显高于非ARDS组〔CC16（mg/L）：38.78±14.70比21.87±2.45，sRAGE（pg/L）：2 470.95±288.70比2 013.22±131.15，均 P<0.01〕；ARDS死亡组患者血清CC16和sRAGE水平均明显高于存活组〔CC16（mg/L）：42.02±10.81比30.52±9.47，sRAGE（pg/L）：2 638.34±324.07比2 279.91±163.70，均 P<0.01〕。ROC曲线显示，单独检测血清CC16、sRAGE诊断ARDS的AUC分别为0.859〔95%可信区间（95% CI）为0.808～0.911〕和0.821（95% CI为0.762～0.879），最佳截断值分别为25.76 mg/L和2 203.00 pg/L；两者联合诊断ARDS的AUC达0.932（95% CI为0.900～0.965），敏感度为89.0%，特异度为87.6%。单独检测血清CC16、sRAGE预测ARDS患者住院期间死亡的AUC分别为0.747（95% CI为0.651～0.843）和0.819（95% CI为0.737～0.902），最佳截断值分别为32.95 mg/L和2 554.50 pg/L；两者联合预测ARDS患者死亡的AUC可达0.900（95% CI为0.828～0.972），敏感度为88.7%，特异度为84.5%。 结论:血清CC16和sRAGE对ARDS的诊断及预后评估具有临床价值，且两者联合检测早期诊断ARDS及预测预后的能力明显优于单独检测。

abstractsObjective:To explore the clinical significance of the combined detection of Clara cell secretory protein 16 (CC16) and soluble receptor for advanced glycation end product (sRAGE) in the diagnosis and prognosis of acute respiratory distress syndrome (ARDS).Methods:100 ARDS patients admitted to the intensive care unit (ICU) of Chu Hsien-I Memorial Hospital of Tianjin Medical University from July 2019 to September 2020 were enrolled as the ARDS group, and 100 non-ARDS patients admitted to the ICU during the same period were enrolled as the control group. The general information, vital signs, blood gas analysis, serum CC16 and sRAGE levels, duration of mechanical ventilation, length of ICU stay and prognosis during hospitalization were collected. The receiver operating characteristic (ROC) curve was drawn and the area under ROC curve (AUC) was calculated to evaluate the clinical value of CC16 and sRAGE lonely or combination in the diagnosis and prognosis of ARDS.Results:The duration of mechanical ventilation in the ARDS group was significantly longer than that in the non-ARDS group (days: 15.44±3.04 vs. 12.61±3.73, P < 0.01), and the hospitalization mortality was higher (38.0% vs. 9.0%, P < 0.01), but there was no significant difference in gender, age, body mass index (BMI), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score or the length of ICU stay between the two groups. There were 62 ARDS patients survived and 38 ARDS patients died during hospitalization. The APACHEⅡ score of the death group was significantly higher than that of the survival group (23.55±2.83 vs. 19.40±4.10, P < 0.01), but there was no significant difference in age, BMI, oxygenation index, mean arterial pressure, duration of mechanical ventilation or the length of ICU stay between the two groups. The serum levels of CC16 and sRAGE in the ARDS group were significantly higher than those in the non-ARDS group [CC16 (mg/L): 38.78±14.70 vs. 21.87±2.45, sRAGE (pg/L): 2 470.95±288.70 vs. 2 013.22±131.15, both P < 0.01]; and the serum levels of CC16 and sRAGE of ARDS patients in the death group were significantly higher than those in the survival group [CC16 (mg/L): 42.02±10.81 vs. 30.52±9.47, sRAGE (pg/L): 2 638.34±324.07 vs. 2 279.91±163.70, both P < 0.01]. ROC curve showed that the AUC of CC16 and sRAGE in the diagnosis of ARDS alone were 0.859 [95% confidence interval (95% CI) was 0.808-0.911] and 0.821 (95% CI was 0.762-0.879), and the best cut-off values were 25.76 mg/L and 2 203.00 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.932 (95% CI was 0.900-0.965) with the sensitivity of 89.0% and the specificity of 87.6%. The AUC of CC16 and sRAGE in predicting the death of patients with ARDS during hospitalization were 0.747 (95% CI was 0.651-0.843) and 0.819 (95% CI was 0.737-0.902), and the best cut-off values were 32.95 mg/L and 2 554.50 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.900 (95% CI was 0.828-0.972) with the sensitivity of 88.7% and the specificity of 84.5%. Conclusions:Serum CC16 and sRAGE have clinical value for the diagnosis and prognosis of ARDS. The combined detection of them is superior to individual detection for early prediction of ARDS and prognosis.