Objective: To explore the biomarkers that applied to pulmonary acute respiratory distress syndrome (ARDS) and extrapulmonary ARDS respectively. Methods: A total of 49 eligible patients with ARDS were selected from Department of Respiratory intensive care unite (ICU) , Department of General ICU and Department of Emergency ICU, the Second Affiliated Hospital of Nanchang University, during April 2015 and February 2016, and divided into pulmonary ARDS group (n=26) and extrapulmonary ARDS group (n=23) according to primary causes. Totally 19 cases from healthy examination personnel were served as control. Acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ) score and lung injury score of all hospitalized patients were completed within 24 hours after the diagnosis of ARDS and the serum levels of angiogenin2 (Ang-2) , surfactant protein D (SP-D), soluble receptor for advanced glycation end products (sRAGE), Krebs von den Lungen-6 (KL-6) were measured. Then the 28-day outcomes were observed. The serum levels of the biomarkers were compared between each group and correlation analysis was conducted between different indexes. Finally, The relationship between the four biomarkers and the outcome of each group was analyzed. Results: The serum level of Ang-2 in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[1 462 (569, 3 638) and 4 568 (2 236, 8 457) vs 460 (389, 578) ng/L, all P<0.05], and the serum level of Ang-2 was significantly higher in extrapulmonary ARDS group than that in pulmonary ARDS group (P<0.05). The serum level of SP-D in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[5.9 (2.5, 22.7) mg/L and 3.7 (1.7, 6.5) vs 1.9 (0.6, 4.4) mg/L, all P<0.05], and the serum level of SP-D was significantly higher in pulmonary ARDS group than that in extrapulmonary ARDS group (P<0.05). The serum level of sRAGE in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[238 (101, 583) and 229 (114, 443) vs 117 (88, 176) ng/L, all P<0.05]. The serum level of KL-6 in pulmonary ARDS group was significantly higher than that in control group[10 435 (3 401, 17 607) vs 4 780 (3 962, 5 320) U/L, P<0.05]. Increased serum levels of SP-D (OR=1.089, 95% CI: 1.001-1.085) and KL-6 (OR=1.206, 95% CI: 1.016-1.432) at the early stage were the independent prognostic factors for the 28-day mortality for pulmonary ARDS. Advanced age (OR=2.622, 95% CI: 1.046-6.574) was the independent prognostic factor for the 28-day mortality for extrapulmonary ARDS. Conclusion: SP-D and KL-6 may be the serum biomarkers of pulmonary ARDS and Ang-2 may be the serum biomarker of extrapulmonary ARDS.
目的： 探讨分别适用于肺内源性急性呼吸窘迫综合征(ARDS)和肺外源性ARDS的血清生物标志物。 方法： 选取2015年4月至2016年2月期间在南昌大学第二附属医院呼吸科重症监护病房(ICU)、综合ICU和急诊ICU住院的ARDS患者共49例，按原发病因将其分为肺内源性ARDS组(26例)及肺外源性ARDS组(23例)。选取同期健康体检者19例为对照组。对所有入组患者在诊断ARDS后24 h内完成急性生理学与慢性健康状况评分系统Ⅲ(APACHE Ⅲ)评分及肺损伤评分，检测血清血管生成素2(Ang-2)，肺泡表面活性物质相关蛋白D(SP-D)，可溶性晚期糖基化终末产物受体(sRAGE)，Ⅱ型肺泡细胞表面抗原(KL-6)水平，并观察28 d预后。各组进行组间比较，然后对各项指标进行相关性分析，最后分析肺内源性ARDS组及肺外源性ARDS组预后与以上4种生物标志物的关系。 结果： 肺内源性ARDS组、肺外源性ARDS组血清Ang-2水平均显著高于对照组[1 462(569，3 638)、4 568(2 236，8 457)比460(389，578)ng/L，均P<0.05]，肺外源性ARDS组显著高于肺内源性ARDS组(P<0.05)。肺内源性ARDS组、肺外源性ARDS组血清SP-D水平均显著高于对照组[5.9(2.5，22.7)、3.7(1.7，6.5)比1.9(0.6，4.4)mg/L，均P<0.05]，肺内源性ARDS组显著高于肺外源性ARDS组(P<0.05)。肺内源性ARDS组、肺外源性ARDS组血清sRAGE水平均显著高于对照组[238(101，583)、229(114，443)比117(88，176)ng/L，均P<0.05]。肺内源性ARDS组血清KL-6水平显著高于对照组[10 435(3 401，17 607)比4 780(3 962，5 320)U/L，P<0.05]。发病早期血清SP-D(OR＝1.089，95% CI：1.001～1.085)和KL-6(OR＝1.206，95% CI：1.016～1.432)水平升高是肺内源性ARDS死亡的独立危险因素；高龄(OR＝2.622，95% CI：1.046～6.574)是肺外源性ARDS死亡的独立危险因素。 结论： SP-D、KL-6可能成为肺内源性ARDS的血清生物标志物，Ang-2可能成为肺外源性ARDS的血清生物标志物。.
Keywords: Acute physiology and chronic health evaluation Ⅲ; Acute respiratory distress syndrome; Biological markers.