Acute lung injury in patients with traumatic injuries: utility of a panel of biomarkers for diagnosis and pathogenesis.
Acute lung injury in patients with traumatic injuries: utility of a panel of biomarkers for diagnosis and pathogenesis.
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DOI：
10.1097/ta.0b013e3181c40728
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发表时间：
2010-05
期刊：
影响因子：
--
通讯作者：
Ware LB
中科院分区：
文献类型：
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作者：
Fremont RD;Koyama T;Calfee CS;Wu W;Dossett LA;Bossert FR;Mitchell D;Wickersham N;Bernard GR;Matthay MA;May AK;Ware LB
急性肺损伤（ALI）的诊断是基于一个共识的临床定义。尽管这个定义很简单，但急性呼吸道感染仍未得到充分诊断和治疗。严重创伤是ALI的一个很好的病因，它代表了ALI患者的一个相对均匀的子集。本研究的目的是开发一组血浆生物标志物，以促进创伤性ALI的诊断，并提高我们对人类ALI发病机制的理解。回顾性巢式病例对照研究了2002年至2006年间在某大学医院创伤重症监护病房（ICU）住院的192例患者。我们比较了107例ALI患者和85例非ALI患者。在ICU入院后72小时内采集血浆。在每个血浆样本中重复测量21种血浆生物标志物。与对照组相比，ALI患者有更高的疾病严重程度评分，更多的机械通气天数，更长的住院时间和更高的死亡率。7项生物标志物（RAGE、PCPIII、BNP、ANG2、IL10、TNF-α和IL8）在鉴别ALI与对照组时具有较高的诊断准确性，其受试者工作特征曲线下面积为0.86 （95% CI 0.82 - 0.92）。利用7种血浆生物标志物的模型在区分创伤性ALI患者和非创伤性ALI患者方面具有很高的诊断准确性。此外，使用一组生物标志物可以深入了解肺泡上皮损伤在早期急性肺损伤发病机制中的可能重要性。
The diagnosis of acute lung injury (ALI) is based on a consensus clinical definition. Despite the simplicity of this definition, ALI remains underdiagnosed and undertreated. Severe trauma is a well-described cause of ALI that represents a relatively homogeneous subset of ALI patients. The goals of this study were to develop a panel of plasma biomarkers to facilitate diagnosis of trauma-induced ALI and to enhance our understanding of the pathogenesis of human ALI. A retrospective nested case control of 192 patients admitted to the trauma intensive care unit (ICU) at a university hospital between 2002 and 2006. We compared 107 patients with ALI to 85 patients without ALI. Plasma was collected within 72 h of ICU admission. Twenty-one plasma biomarkers were measured in duplicate in each plasma sample. Patients with ALI had higher severity of illness scores, more days of mechanical ventilation, longer hospital stays and higher mortality versus controls. Seven biomarkers (RAGE, PCPIII, BNP, ANG2, IL10, TNF-α, and IL8) had a high diagnostic accuracy as reflected by the area under the receiver operating characteristic curve of 0.86 (95% CI 0.82 – 0.92) in differentiating ALI from controls. A model utilizing seven plasma biomarkers had a high diagnostic accuracy in differentiating patients with trauma-induced ALI from trauma patients without ALI. In addition, use of a panel of biomarkers provides insight into the likely importance of alveolar epithelial injury in the pathogenesis of early acute lung injury.