摘要目的 探讨脓毒症及脓毒症合并急性呼吸窘迫综合征 (ARDS)患者外周血血小板-单核细胞聚集体(PMA)水平变化及相关性分析,评估其对脓毒症导致ARDS的诊断价值及意义.方法 本研究纳入2014年7月至2015年12月贵州省人民医院收治的123例脓毒症患者,采用2012 ARDS 柏林定义据是否发展为ARDS分为ARDS组和非ARDS组,非ARDS组61例,ARDS组62例,ARDS组按ARDS柏林定义分为3组,轻度组22例,中度组21例,重度组19例.所有纳入的病例诊断当天留取血标本,检测PMA水平;同时测定IL-6水平,计算PaO2/FiO2,并同步记录各组的急性生理学以及慢性健康状况评分(APACHE Ⅱ评分),应用SPSS 17.0软件,计数资料采用χ2检验;计量资料组间比较采用独立样本t检或单因素方差分析,采用Pearson线性相关对PMA、IL-6、APACHE Ⅱ、PaO2/FiO2进行相关性分析,建立受试者工作特征曲线(ROC),分析PMA、IL-6、APACHE Ⅱ对ARDS的发生价值,以P<0.05为差异有统计学意义.结果 脓毒症并ARDS组与非ARDS组相比较,IL-6、APACHE II评分、PMA水平明显升高差异均有统计学意义(P<0.01),ARDS组中各指标随病情程度加重而增加差异均具有统计学意义(P<0.01).相关分析显示,外周血 PMA与IL-6(r=0.791,P<0.01)、APACHEⅡ评分(r=0.641,P<0.01)均呈明显正相关;与PaO2/FiO2呈明显负相关(r=-0.857,P<0.01).PMA预测ARDS的ROC曲线下面积为0.833,最佳临界值为8.8%时的特异度为0.82,灵敏度为0.71,高于APACHEⅡ评分、IL-6的预测价值.结论 PMA在脓毒症患者中升高,随着病情进展并发ARDS后PMA升高更加显著, PMA与IL-6、APACHEII具有显著的相关性,预测ARDS的价值优于IL-6、APACHE Ⅱ评分,可以作为判断脓毒症病情程度及预测ARDS的辅助指标.

abstractsObjective To investigate significance in changes in level of platelet monocyte aggregates (PMA) associated with acute respiratory distress syndrome (ARDS) in patients with sepsis and discuss the role of PMA in the genesis of ARDS in order to evaluate the its diagnostic value and the significance in the severity of damage of lung in patients with sepsis. Methods This study was carried out in the Guizhou Provincial People's Hospital and 123 sepsis patients admitted from July 2014 to December 2015 were enrolled according the 2012 ARDS Berlin diagnostic criteria. The patients were divided into ARDS group (n=62) and non-ARDS group (n=61). The ARDS group were further divided into 3 subgroups according to Berlin criteria, namely mild group (n=22), moderate group (n=21), and severe group (n=19). Of all patients, blood samples were collected to determine the level of PMA using fl ow cytometry (FCM) and the level of IL-6 using enzyme linked immunosorbent assay (ELISA) method. Acute physiology and chronic health status (APACHEⅡ)score in each group were recorded at admission. Comparisons of PMA, IL-6 and APACHE Ⅱ score were carried out among groups. Receiver operating characteristic (ROC) curve were used to evaluate the signifi cance and value of PMA in predicting ARDS. Results Compared with non-ARDS group, APACHE Ⅱ score, IL-6 level, PMA level in ARDS group were signifi cantly higher with statistically signifi cant differences (P<0.01). When the severity of ARDS increased, the level of each biomarker increased with statistically significant differences (P<0.01). Correlation analysis showed that peripheral blood PMA positively correlated with IL-6 (r=0.791, P<0.01) and APACHE Ⅱ score (r=0.641, P<0.01), while it negatively correlated with PaO2/FiO2(r=-0.857, P<0.01).Area under the ROC curve of PMA was 0.833 for predicting ARDS, and when the optimal cutoff value was 8.8%, the specifi city was 82%, and sensitivity was 71%, which were higher than those of APACHE Ⅱ score and IL-6. Conclusions The increase of PMA in patients with sepsis is closely associated with the severity of ARDS. The PMA has correlation with IL-6 and APACHE II, and it is superior to IL-6 and APACH II score for predicting ARDS. PMA can be used as an adjuvant indicator to judge the sepsis severity and to predict the occurrence of ARDS.