Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation
Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation
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DOI：
10.1007/s00134-014-3524-0
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发表时间：
2015-01-01
影响因子：
38.9
通讯作者：
Papazian, Laurent
中科院分区：
文献类型：
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作者：
Forel, Jean-Marie;Guervilly, Christophe;Papazian, Laurent
ARDS后纤维增生的特异性生物标志物可用于识别可从旨在调节纤维增生的治疗（如皮质类固醇）中获益的患者。本前瞻性研究的目的是确定N端肽III型前胶原的最佳阈值。（NT-PCP-III）在非缓解性ARDS中的应用，以根据结果验证该阈值。如果满足以下所有标准，则包括所有连续的患有未缓解的ARDS的患者：持续至少5天的中度至重度ARDS，进行肺活检，在活检前1周内获得血清和肺泡NT-PCP-III，并且没有记录的感染禁忌皮质类固醇。在研究的验证队列部分，如果患者表现为持续的中度至重度ARDS，则在第7天将其纳入研究。血清和肺泡NT-PCP-III在纤维增生患者中较高。使用9 μ g/L的阈值，肺泡NT-PCP-III诊断纤维增生的准确性最高（灵敏度= 89.5%，特异性= 92.3%）。关于验证队列中包括的51名患者，在肺泡NT-PCP-III水平高于9 μ g/L的患者中，第60天的死亡率增加（69%对17%，p < 0.001）。在第7天，非存活者的平均肺泡NT-PCP-III水平高出8.1倍（p = 0.03）。在持续性ARDS中，在第7天进行的BAL上NT-PCP-III的测定能够识别具有纤维增生的患者，这些患者可以被包括在皮质类固醇或任何其他可能有助于解决肺纤维增生的治疗的试验中。
A specific biomarker of post-ARDS fibroproliferation could be useful in the identification of patients who could benefit from therapies aiming to modulate fibroproliferation such as corticosteroids.The aim of this prospective study was to determine the best threshold of the N-terminal-peptidetype III procollagen (NT-PCP-III) in non-resolving ARDS to validate this threshold according to the outcome.Concerning the best threshold of NT-PCP-III, all consecutive patients with a non-resolving ARDS were included if all the following criteria were fulfilled: moderate to severe ARDS lasting for at least 5 days, lung biopsy performed, serum and alveolar NT-PCP-III obtained within 1 week prior to biopsy, and no documented infection contra-indicating the corticosteroids. In the validation cohort part of the study, patients were included at day 7 if they presented a persistent moderate to severe ARDS.Nineteen of 32 patients had fibroproliferatio nonbiopsy. Serum and alveolar NT-PCP-III were higher in patients with fibroproliferation. Using a threshold of 9 A mu g/L, alveolar NT-PCP-III had the highest accuracy for diagnosing fibroproliferation (sensitivity = 89.5 % and specificity = 92.3 %). Regarding the 51 patients included in the validation cohort, the mortality rate at day 60 was increased in patients presenting an alveolar NT-PCP-III level higher than 9 A mu g/L (69 vs. 17 %, p < 0.001). The mean alveolar level of NT-PCP-III on day 7 was 8.1-fold higher in nonsurvivors (p = 0.03).The determination of NT-PCP-III on BAL done at day 7 in persistent ARDS is able to identify patients with fibroproliferation who could be included in a trial of corticosteroids or any other treatment that might help resolve lung fibroproliferation.