目的:探讨血清Kerbs von Lungren 6 (KL-6)水平在创伤性急性呼吸窘迫综合征(ARDS)中的变化及其诊断价值.方法:共选取本院从2013年1月至2014年12月54例创伤性ARDS住院患者,所有病例均符合2011年"ARDS柏林诊断标准".对照人群来自于到本院就诊而未发生ARDS的创伤患者53例.另选择到本院体检者50例,作为基础对照.采用ELISA检测了各人群血清KL-6水平,并进行肺损伤预测评分(LIPS)、肺损伤评分(LIS),检测PaO2/FiO2.比较KL-6在不同人群中的表达情况,及其与LIPS、LIS、PaO2/FiO2的相关性.采用受试者工作特征(ROC)曲线评价血清KL-6在创伤性ARDS中的诊断价值.结果:血清KL-6水平在创伤性ARDS患者中明显上升,并且合并多器官功能障碍(MODS)的患者血清KL-6水平均明显增高于无并发多器官功能障碍患者.血清KL-6水平与LIPS、LIS评分呈正相关,与PaO2/FiO2呈负相关.ROC曲线分析显示,血清KL-6评分在预测创伤性ARDS方面有显著意义.其曲线下面积(AUC)为0.891,95%可信区间(confidence interval)为0.831~0.952(P<0.01).当血清KL-6水平大于426.4 units·ml-1时,预测创伤性ARDS的敏感度为62.9 %,特异性为91.2 %.结论:KL-6是创伤性ARDS的良好生物标志物,可以用于该疾病的早期诊断. |
Objective: To study the feasibility of serum Kerbs von Lungren 6 antigen (KL-6) in diagnosing and predicting traumatic acute respiratory distress syndrome (ARDS). Methods: 54 cases of ARDS patients were collected, who were hospitalized in department of ICU, the people's hospital of Wujiang District, from January 2013 to December 2014. The diagnosis of all patients conformed to the Berlin Definition of ARDS (2011). 53 traumatic patients without the occurrence of ARDS and 50 healthy volunteers were examined simultaneously. The concentrations of serum KL-6 were examined with ELISA, and the corresponding clinical data, including lung injury prediction score (LIPS), Murray lung injury sore (LIS), PaO2/FiO2, were collected. The relationship between serum KL-6 and LIPS, LIS, PaO2/FiO2 was analyzed. In addition, the diagnostic significance of serum KL-6 was evaluated using ROC curve for diagnosing traumatic ARDS. Results: Serum KL-6 levels were higher in the traumatic ARDS patients than the non-ARDS patients and the healthy control individuals. The KL-6 levels in the patients with MODS was higher than those free of MODS. The levels of serum KL-6 were positively correlated with LIPS and LIS, but negatively correlated with PaO2/FiO2. ROC curve analysis showed that serum KL-6 can be used for diagnosing the traumatic ARDS( AUC=0.891,95% CI: 0.831-0.952,P<0.01). The sensitivity and specificity were 62.9 % and 91.2 % respectively when the level of KL-6 was higher than 426.4 units·ml-1. Conclusion: KL-6 may be a useful biomarker for the diagnosis of traumatic ARDS. |
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