摘要目的 探讨血清血管内皮钙黏蛋白(vascular endothelial cadherine,VE-Cad)水平与脓毒症并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者疾病严重程度及预后的关系.方法 2015年6月至2017年12月天津医科大学第二医院综合ICU收治的脓毒症并发ARDS患者48例,选取同期30名健康体检者作为健康对照组.48例ARDS患者中轻度17例,中度18例,重度13例.检测第1、3、7天血清VE-Cad、TNF-α和IL-6水平.比较各组血管外肺水指数(extravascular lung water index,EVLWI)、肺血管通透性指数(pulmonary vascular permeability index,PVPI),肺损伤评分(lung injury score,LIS)、急性生理学与慢性健康状况(APACHEⅡ)评分和序贯器官功能衰竭(SOFA)评分.两组间比较采用t检验或χ2检验,多组间比较采用单因素方差分析.结果 入院第1天ARDS组患者血清VE-Cad为(5.67±0.29)μg/L,高于健康对照组的(0.28±0.03)μg/L,两组比较差异有统计学意义(t=101.2,P<0.01).轻、中、重度ARDS患者血清VE-Cad水平分别为(1.52±0.59)、(3.45±0.68)和(4.86±0.53)μg/L,组间比较差异有统计学意义(F=15.45,P<0.01).ARDS患者血清VE-Cad与EVLWI、PVPI、LIS、TNF-α和IL-6均正呈相关(r值分别为0.640、0.601、0.507、0.584和0.456,均P<0.01).17例死亡组患者的氧合指数(PaO2/FiO2)为(146.74±16.45)mmHg(1 mmHg=0.133 kPa),血清白蛋白为(23.18±3.24)g/L,均低于31例生存组患者的(245.42±12.13)mmHg和(29.16±3.45)g/L,比较差异均有统计学意义(t值分别为23.72、5.865,均P<0.01);而EVLWI、PVPI、LIS、乳酸、机械通气时间、7 d液体平衡量、APACHEⅡ评分和SOFA评分均高于生存组.生存组患者第1、3和7天血清VE-Cad水平分别为(3.36±0.47)、(1.95±0.42)和(0.96±0.28)μg/L,均低于死亡组患者的(4.72±0.96)、(3.87±0.28)和(3.92±0.53)μg/L,比较均差异有统计学意义(t值分别为8.801、16.86和25.42,均P<0.01).当VE-Cad的截断值为3.035μg/L时,其预测ARDS患者死亡的灵敏度为100.00％,特异度为58.06％.结论 脓毒症合并ARDS患者血清VE-Cad水平升高,其水平与疾病严重程度相关,可作为判断预后的指标之一.

abstractsObjective To investigate the prognostic significance of serum vascular endothelial cadherine (VE-Cad) in patients with acute respiratory distress syndrome (ARDS) induced by sepsis . Methods A prospective observational study was performed between June 2015 and Dec 2017 ,and 48 ARDS patients induced by sepsis from intensive care unit (ICU) were enrolled .And 30 healthy volunteers were enrolled as control .ARDS group was divided into mild group (n=17) ,moderate group (n=18) and severe group (n= 13) .The dynamic levels of serum VE-Cad ,tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were monitored at day 1 ,3 and 7 of admission .Clinical data including extravascular lung water index (EVLWI) ,pulmonary vascular permeability index (PVPI) ,lung injury score (LIS) , APACHEⅡand SOFA were also collected .The t-test or chi square test were used in the comparison between the two groups .One-way ANOVA was used for comparison among multiple groups .Results The serum VE-Cad level of septic group was higher than control group at day 1 of admission ([5 .67 ± 0 .29] vs [0 .28 ± 0 .03] μg/L ,t= 101 .2 , P< 0 .01) .The serum VE-Cad levels in the mild group , moderate group and severe group were (1 .52 ± 0 .59) ,(3 .45 ± 0 .68) ,and (4 .68 ± 0 .53) μg/L , respectively (F=15 .45 ,P<0 .01) .There were positive correlation between VE-Cad levels and EVLWI , PVPI ,LIS ,TNF-αand IL-6 (r=0 .640 ,0 .601 ,0 .507 ,0 .584 ,and 0 .456 ,respectively ,all P<0 .01) . The PaO2/FiO2 and serum albumin level in death group (n=17) were lower than survival group (n=31) ([146 .74 ± 16 .45] vs [245 .42 ± 12 .13] mmHg [1 mmHg=0 .133 kPa] ,t=23 .72 ,P<0 .01 ;[23 .18 ± 3.24]vs[29.16±3.45]g/L,t=5.865,P< 0.01,respectively),andEVLWI ,PVPI,LIS,serum lactate ,mechanical ventilation time ,7 d fluid balance ,APACHEⅡ and SOFA in death group were all higher than survival group .The serum VE-Cad levels at day 1 ,3 and 7 in death group were all higher than survival group ([4 .72 ± 0 .96] vs [3 .36 ± 0 .47]μg/L ,t=8 .801;[3 .87 ± 0 .28] vs [1 .95 ± 0 .42]μg/L , t=16 .86 ;[3 .92 ± 0 .53] vs [0 .96 ± 0 .28]μg/L ,t=25 .42 ,respectively ,all P<0 .01) .The area under curve (AUC ) of VE-Cad for ARDS outcome prediction was 0 .878 with sensitivity of 100 .00％ and specificity of 58 .06％ with a cutoff of 3 .035 μg/L .Conclusion Serum VE-Cad level increases in patients with ARDS induced by sepsis ,and positively correlates with disease severity ,which could be a potential predictor for prognosis .