Plasma receptor for advanced glycation end products and clinical outcomes in acute lung injury
Plasma receptor for advanced glycation end products and clinical outcomes in acute lung injury
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DOI：
10.1136/thx.2008.095588
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发表时间：
2008-12-01
期刊：
影响因子：
10
通讯作者：
Matthay, M. A.
中科院分区：
文献类型：
--
作者：
Calfee, C. S.;Ware, L. B.;Matthay, M. A.
目的：确定晚期糖基化终产物受体（RAGE）的基线血浆水平（一种肺泡I型细胞损伤的新标志物）是否与急性肺损伤的严重程度和结果相关，以及血浆RAGE水平是否受到低潮气量通气的影响。设计、设置和参与者：测量676名受试者的血浆RAGE水平，这些受试者参加了一项大型随机对照试验，该试验采用低潮气量通气治疗急性肺损伤。测量和主要结果：较高的基线血浆RAGE与肺损伤的严重程度增加有关。此外，较高的基线RAGE与死亡率增加相关(RAGE每增加1个对数，死亡OR为1.38 (95% CI 1.13至1.68)；P = 0.002)，随机分配到较高潮气量的患者无呼吸机和器官衰竭天数更少。在调整了年龄、性别、疾病严重程度和败血症或创伤的多变量模型中，这些关联仍然存在。血浆RAGE与低潮气量组的结果无相关性（未校正分析中相互作用p = 0.09）。在两个潮气量组中，血浆RAGE水平在前3天下降；然而，低潮量组下降幅度为15% （p = 0.02; 95% CI 2.4% ~ 25.0%）。结论：血浆RAGE基线水平与高潮气量通气急性肺损伤患者的临床结局密切相关。低潮气量通气可能是有益的，部分原因是减少肺泡上皮的损伤。
Objectives: To determine whether baseline plasma levels of the receptor for advanced glycation end products (RAGE), a novel marker of alveolar type I cell injury, are associated with the severity and outcomes of acute lung injury, and whether plasma RAGE levels are affected by lower tidal volume ventilation.Design, setting and participants: Measurement of plasma RAGE levels from 676 subjects enrolled in a large randomised controlled trial of lower tidal volume ventilation in acute lung injury.Measurements and main results: Higher baseline plasma RAGE was associated with increased severity of lung injury. In addition, higher baseline RAGE was associated with increased mortality (OR for death 1.38 (95% CI 1.13 to 1.68) per 1 log increment in RAGE; p = 0.002) and fewer ventilator free and organ failure free days in patients randomised to higher tidal volumes. These associations persisted in multivariable models that adjusted for age, gender, severity of illness and the presence of sepsis or trauma. Plasma RAGE was not associated with outcomes in the lower tidal volume group (p = 0.09 for interaction in unadjusted analysis). In both tidal volume groups, plasma RAGE levels declined over the first 3 days; however, the decline was 15% greater in the lower tidal volume group (p = 0.02; 95% CI 2.4% to 25.0%).Conclusions: Baseline plasma RAGE levels are strongly associated with clinical outcomes in patients with acute lung injury ventilated with higher tidal volumes. Lower tidal volume ventilation may be beneficial in part by decreasing injury to the alveolar epithelium.