ABSTRACT
Objective To select valuable biomarkers for diagnosis and predicting outcome of sepsis-related acute respiratory distress syndrome(ARDS) from D-dimmer (DD),yon Willebrand factor (vWF),platelet (PLT),N terminal-pro brain natriuretic peptide (NT-ProBNP),interleukin-6 (IL-6),interleukin-8 (IL-8) and surfactant protein D (SP-D).Methods A total of 48 sepsis accompanied with ARDS patients and 40 sepsis patients were prospectively studied with comparison.The clinical characteristics of all the patients were recorded in detail.The blood samples were obtained within 24 hours of ICU admission.The concentration or activity of the seven biomarkers was quantitatively assayed and the results were recorded.To select the most valuable biomarkers as clinical indices,diagnosis model and death predictive model were constructed by Logistic regression.Results Among the seven candidate biomarkers,SP-D,vWF and IL-8 showed the most value.Their area under the receiver operator characteristic curve (ROC) were 0.758 (P ＜ 0.01),0.783 (P ＜ 0.01) and 0.747 (P ＜ 0.01) respectively,and raised to 0.847 (P ＜ 0.001) when the three biomarkers were combined.IL-8,age greater than or equal to 60 years and APACHE Ⅱ score greater than or equal to 20 were related to ARDS death with 12.138(lnIL-8)(P=0.022),6.157(P=0.040) and7.415(P=0.014) of OR values respectively.Conclusion SP-D,vWF,IL-8 should be valuable for early prediction of sepsis-induced ARDS and the diagnostic accuracy raised through combined utilization.IL-8 may be predictable for prognosis of sepsis related ARDS and the comprehensive evaluation combining clinical indices with IL-8 should be suggested in clinical practice.
ABSTRACT
Objective:To investigate the concentration of pulmonary surfactant-associated protein D ( SP-D) and interleukin-8 (IL-8) in the bronchoalveolar lavage fluid (BALF) of ACOS patients undergoing mechanical ventilation (MV). Methods:38 patients with ACOS undergoing MV were involved in the study. According to the APACHEⅡscore, the patients were divided into the remission group (n=20) and the aggravation group (n=18). BALF was collected on the 1st and 5th days after MV. The content of IL-8 and SP-D in BALF was measured by ELISA. The levels of IL-8 and SP-D in BALF of the patients with different severity were compared. Results:The level of SP-D was significantly higher on the 5th day than on the 1st day in the remission group,and it decreased more ob-viously in the worsening group (P<0. 05). The level of IL-8 decreased gradually in the remission group but increased gradually in the worsening group. The level of SP-D was negatively correlated with IL-8 level and APACHEⅡ score. Conclusion:The findings suggest that the levels of SP-D and IL-8 in BALF are correlated with prognosis of ACOS patients undergoing MV,and it may prove to be useful as a guidance of therapy and prognosis.
ABSTRACT
Objective To investigate the significance of serum krebs Yon den lungen-6(KL-6), surfactant protein A(SP-A), surfactant protein D(SP-D )and matrix metalloprotease 7(MMP-7) in the diagnosis of idiopathic pul-monary fibrosis (IPF) and its relationship with pulmonary function .Methods Serum levels of KL-6, SP-D, SP-A and MMP-7 were detected by ELISA in 38 patients with IPF and serum from 38 patients with pneumonia and 38 normal controls.Serum levels of markers were further analyzed by operating characteristic curve receiver (ROC), from which the ideal level of each serum marker was obtained , and the follow-up of 6 months in patients with IPF . Explore the significance of the diagnosis of IPF and its correlation with pulmonary function .Results The expres-sion of MMP-7, SP-A, SP-D and KL-6 in serum of IPF patients was higher than that in the control group and healthy control group ( P<0.05) .The optimal cutoff value of KL-6 was 723.0 U/ml, SP-A was 67.2 ng/ml, SP-D was 98.1 ng/ml, and MMP-7 was 10.1 ng/ml.The sensitivity of KL-6 was 71.1% and 98.7%, SP-A was 81.6%and 97.4%, SP-D was 81.6%and 97.4%, MMP-7 was 68.4%and 98.7%.The sensitivity of combined KL-6, SP-A, SP-D and MMP-7 four serum markers was 100%, compared with a single serum index , the P value was less than 0.05, with statistical significance .IPF patients serum SP-A, MMP-7 and forced vital capacity within 6 months were significantly correlated(r1 =-0.574,P1 <0.001;r2 =-0.465,P2 =0.003).Conclusion KL-6, SP-A, SP-D and MMP-7 were highly expressed in serum of patients with IPF , and in the diagnosis of IPF , com-bined detection of 4 serum markers can improve the early diagnosis of IPF patients .Combined serum SP-A and MMP-7 levels can improve the accuracy of the IPF patients with pulmonary function changes , the prediction of dis-ease progression has a certain significance .