The predictive role of serum and bronchoalveolar lavage cytokines and adhesion molecules for acute respiratory distress syndrome development and outcome.
The predictive role of serum and bronchoalveolar lavage cytokines and adhesion molecules for acute respiratory distress syndrome development and outcome.
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DOI：
10.1186/rr193
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发表时间：
2002
影响因子：
5.8
通讯作者：
Bouros D
中科院分区：
文献类型：
--
作者：
Agouridakis P;Kyriakou D;Alexandrakis MG;Prekates A;Perisinakis K;Karkavitsas N;Bouros D
许多细胞因子和粘附分子在急性呼吸窘迫综合征（ARDS）中的预测作用尚未得到系统研究。我们前瞻性地测量了 65 名患者入院后 2 小时内血清和支气管肺泡灌洗液 (BALF) 中的肿瘤坏死因子 α (TNF-α)、白细胞介素 (IL)-1、可溶性血管粘附分子 1 (VCAM-1) 和可溶性细胞间粘附分子 1 (ICAM-1)。将患者分为：符合 ARDS 标准的患者（n = 23，A 组）、处于 ARDS 前期并在 24 小时内发生 ARDS 的患者（n = 14，B 组）以及处于 ARDS 前期但从未发生 ARDS 的患者（n = 28，C 组）。所有测量的分子仅在患有或不患有 ARDS 的死亡患者的血清中发现较高水平 (P < 0.05 – P < 0.0001)。处于危险中的患者在其血清（89％至95％）和BALF（86％至92％）水平中对ARDS发展的测量分子表现出良好的阴性预测值（NPV）。与 BALF 相比，所有组中 IL-1 和粘附分子的血清水平均表现出良好的 NPV（68% 至 96%）、敏感性（60% 至 88%）和生存特异性（74% 至 96%）。血清和 BALF IL-1 中的所有分子均与 APACHE II 相关 (P < 0.05 – P < 0.0001)。血清和BALF IL-1以及BALF TNF-α与PaO2/FiO2呈负相关（均P < 0.05）。研究的分子对于血清和 BALF 中的 ARDS 发展具有良好的 NPV。血清而不是 BALF 水平似乎与结果相关。
The predictive role of many cytokines and adhesion molecules has not been studied systematically in acute respiratory distress syndrome (ARDS). We measured prospectively tumour necrosis factor alpha (TNF-α), interleukin (IL)-1, soluble vascular adhesion molecule-1 (VCAM-1) and soluble intercellular adhesion molecule-1 (ICAM-1) in serum and bronchoalveolar lavage fluid (BALF) within 2 hours following admission, in 65 patients. The patients were divided into: those fulfilling the criteria for ARDS (n = 23, group A), those who were pre-ARDS and who developed ARDS within 24 hours (n = 14, group B), and those on pre-ARDS but who never developed ARDS (n = 28, group C). All the measured molecules were only found at higher levels in the serum of patients that died either with or without ARDS (P < 0.05 – P < 0.0001). Patients at risk exhibited a good negative predictive value (NPV) of the measured molecules for ARDS development both in their serum (89 to 95%) and BALF (86 to 92%) levels. In contrast to BALF, serum levels of IL-1 and adhesion molecules exhibited a good NPV (68 to 96%), sensitivity (60 to 88%) and survival specificity (74 to 96%) in all groups. All molecules in serum and BALF IL-1 were correlated with the APACHE II (P < 0.05 – P < 0.0001). Serum and BALF IL-1 as well as BALF TNF-α were negatively correlated to PaO2/FiO2 (all P < 0.05). The studied molecules have good NPV for ARDS development both in serum and BALF. Serum rather than BALF levels seem to be related to outcome.