血清葡萄糖调节蛋白78联合肺血管阻力指数对急性肺损伤患者预后的评估价值

Evaluation value of serum GRP78 combined with pulmonary vascular resistance index on prognosis of patients with acute lung injury

摘要:

目的 探讨葡萄糖调节蛋白78（GRP78）联合肺血管阻力指数（PVRI）对急性肺损伤（ALI）患者预后的评估价值。方法 选取2019年1月—2021年6月三亚市人民医院收治的接受正压通气治疗的ALI患者120例。根据急性生理和慢性健康评估Ⅱ（APACHE Ⅱ）评分分组，高危组APACHE Ⅱ> 20分（n =42），低中危组APACHE Ⅱ≤20分（n =78）；根据患者不同预后分为预后良好组（n =31）和预后不良组（n =89）。Spearman相关性分析血清GRP78水平和PVRI与APACHEⅡ评分的相关性；采用多因素Logistic回归分析ALI患者预后不良影响因素；ROC曲线分析血清GRP78联合PVRI对ALI患者预后不良的评估价值。结果 高危组血清GRP78水平和PVRI均高于低中危组（P <0.05）。ALI患者血清GRP78水平（r_s =0.425）和PVRI水平（r_s =0.511）与APACHEⅡ评分均呈正相关（P <0.05）。预后不良组休克比例高于预后良好组，ICU时间、机械通气时间长于预后良好组，APACHEⅡ评分、GRP78水平、PVRI高于预后良好组（P <0.05）。多因素Logistic回归分析结果显示：休克［O^R=4.061（95% CI：1.288，12.806）］、APACHEⅡ评分> 20分［O^R=1.093（95% CI：1.013，1.179）］和高GRP78［O^R=1.035（95% CI：1.016，1.054）］、PVRI［O^R=1.177（95% CI：1.007，1.375）］为ALI患者预后不良的危险因素（P <0.05）。ROC曲线显示，GRP78、PVRI分别为108.10 ng/mL、29.21（kPa·s）/L时，评估ALI患者预后不良的AUC分别为0.786、0.796，敏感性分别为64.5%（95% CI：0.610，0.687）、84.3%（95% CI：0.811，0.875），特异性分别为71.0%（95% CI：0.673，0.742）、76.0%（95% CI：0.732，0.818）；GRP78+PVRI联合评估ALI患者预后不良的AUC为0.895，敏感性为80.7%（95% CI：0.771，0.849）、特异性为85.4%（95% CI：0.819，0.895）。结论 血清GRP78水平和PVRI升高与ALI患者病情严重程度和预后相关，联合检测可提高不良预后的评估价值。

Abstract:

Objective To explore the evaluation value of serum glucose regulatory protein 78 (GRP78) combined with pulmonary vascular resistance index (PVRI) on the prognosis of patients with acute lung injury (ALI).Methods A total of 120 patients with ALI who received positive pressure ventilation were selected and divided into high-risk groups ( > 20 points, n = 42) and low-medium-risk group ( ≤ 20 points, n = 78). According to different prognosis, they are divided into good prognosis group (n = 31) and poor prognosis group (n = 89). Correlation of serum GRP78 levels and PVRI with APACHE Ⅱ scores was analyzed with Spearman correlation analysis. Multifactorial logistic regression analysis was used to analyse the factors influencing poor prognosis in ALI patients. The value of serum GRP78 combined with PVRI in the assessment of poor prognosis in patients with ALI was analysed with ROC curves.Results The levels of serum GRP78 and PVRI in high-risk group were higher than those in low-medium-risk group (P < 0.05). Spearman correlation analysis showed that the levels of serum GRP78 (r_s = 0.425) and PVRI (r_s = 0.511) were positively correlated with APACHE Ⅱ score (P < 0.05). The proportion of shock in the poor prognosis group was higher than that in the good prognosis group, the ICU time and mechanical ventilation time were longer than those in the good prognosis group, and the APACHE Ⅱ score, GRP78, and PVRI were higher than those in the good prognosis group (P < 0.05). Multivariate logistic regression analysis showed that shock [O^R = 4.061 (95% CI: 1.288, 12.806) ], APACHE Ⅱ score > 20 [O^R = 1.093 (95% CI: 1.013, 1.179) ], high GRP78 [O^R = 1.035 (95% CI: 1.016, 1.054) ], and PVRI [O^R = 1.177 (95% CI: 1.007, 1.375) ] were the risk factors of poor prognosis in patients with ALl (P < 0.05). The ROC curve showed that when GRP78 and PVRI were 108.10 ng/mL and 29.21 (kPa·s)/L, the AUC for evaluating the poor prognosis of patients with ALI were 0.786 and 0.796, and the sensitivity and specificity were 64.5% (95% CI: 0.610, 0.687) and 84.3% (95% CI: 0.811, 0.875), 71.0% (95% CI: 0.673, 0.742) and 76.0% (95% CI: 0.732, 0.818), respectively. The AUC of GRP78 + PVRI was 0.895, the sensitivity and specificity were 80.7% (95% CI: 0.771, 0.849) and 85.4% (95% CI: 0.819, 0.895).Conclusion Serum GRP78 levels and elevated PVRI correlate with severity of disease and prognosis in patients with ALI, and the combined test may enhance the value of poor prognostic assessment.