ELEVATED VONWILLEBRAND-FACTOR ANTIGEN IS AN EARLY PLASMA PREDICTOR OF ACUTE LUNG INJURY IN NONPULMONARY SEPSIS SYNDROME
ELEVATED VONWILLEBRAND-FACTOR ANTIGEN IS AN EARLY PLASMA PREDICTOR OF ACUTE LUNG INJURY IN NONPULMONARY SEPSIS SYNDROME
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DOI：
10.1172/jci114733
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发表时间：
1990-08-01
影响因子：
15.9
通讯作者：
MATTHAY, MA
中科院分区：
文献类型：
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作者：
RUBIN, DB;WIENERKRONISH, JP;MATTHAY, MA
在这项45例患者的前瞻性研究中，我们检验了一个假设，即血浆血管性血友病抗原（vWf-Ag）水平的显着升高，内皮细胞损伤的标志物，可能预测急性肺损伤的发展与非肺脓毒症综合征患者。急性肺损伤采用四分评分系统进行量化。在进入研究时，45名患者均无肺损伤证据。随后，15例患者发生肺损伤，30例患者未发生肺损伤。与30名未发生肺损伤的患者相比，15名发生肺损伤的患者的平均血浆vWf-Ag水平显著升高（588 ± 0.01）。204 vs. 338 .+-. 196，对照组百分率，P < 0.01）。此外，血浆vWf-Ag水平≥ 450对于预测非肺脓毒症情况下急性肺损伤的发展是87%敏感和77%特异的。此外，在进入研究时，血浆vWf-Ag > 450和非肺器官衰竭的组合对急性肺损伤的阳性预测值为80%。此外，血浆vWf-Ag水平> 450对确定死亡者的阳性预测值为80%。因此，在非肺性脓毒症患者中，血浆vWf-Ag水平升高是内皮损伤的有用的早期生化标志物，并且具有预测和预后价值。
In this prospective study of 45 patients, we tested the hypothesis that markedly elevated levels of plasma von Willebrand antigen (vWf-Ag) a marker of endothelial cell injury, might predict the development of acute lung injury in patients with nonpulmonary sepsis syndrome. Acute lung injury was quantified on a four-point scoring system. At the time of entry into the study, none of the 45 patients had evidence of lung injury. Subsequently, 15 patients developed lung injury and 30 patients did not develop lung injury. The mean plasma vWf-Ag level was markedly elevated in the 15 patients who developed lung injury compared with the 30 patients who did not develop lung injury (588 .+-. 204 vs. 338 .+-. 196, percentage of control, P < 0.01). Furthermore, a plasma vWf-Ag level .gtoreq.450 was 87% sensitive and 77% specific for predicting the development of acute lung injury in the setting of nonpulmonary sepsis. In addition, the combination of a plasma vWf-Ag > 450 and nonpulmonary organ failure at the time of entry into the study had a positive predictive value of 80% for acute lung injury. Also, a plasma vWf-Ag level > 450 had a positive predictive value of 80% for identifying nonsurvivors. Thus, in patients with nonpulmonary sepsis, an elevated level of plasma vWf-Ag is a useful, early biochemical marker of endothelial injury and it has both predictive and prognostic value.