Soluble form of the receptor for advanced glycation end products is a marker of acute lung injury but not of severe sepsis in critically ill patients
Soluble form of the receptor for advanced glycation end products is a marker of acute lung injury but not of severe sepsis in critically ill patients
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DOI：
10.1097/ccm.0b013e318206b3ca
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发表时间：
2011-03-01
影响因子：
8.8
通讯作者：
Constantin, Jean-Michel
中科院分区：
文献类型：
--
作者：
Jabaudon, Matthieu;Futier, Emmanuel;Constantin, Jean-Michel
目的：晚期糖基化终末产物受体（sCRP）可溶性形式的水平在急性肺损伤时升高。然而，尚不清楚这种增加是否与其参与肺泡上皮损伤或全身炎症有关。无论是否伴有严重脓毒症或脓毒性休克，severity是否是急性肺损伤和急性呼吸窘迫综合征的标志物，在重症监护室中仍不清楚。设计：前瞻性，观察性，临床研究。设置：学术医学中心的重症监护室。患者：共64名连续受试者，分为四组：急性肺损伤/急性呼吸窘迫综合征（n = 15）;急性肺损伤/急性呼吸窘迫综合征加严重脓毒症/脓毒性休克（n = 18）;严重脓毒症/脓毒性休克（n = 16）;和机械通气对照（n = 15）。测量和主要结果：在基线和第3、6和28天（或在重症监护病房出院时，以先发生者为准）测量血浆胰岛素水平。急性肺损伤/急性呼吸窘迫综合征患者的基线血浆sIgA水平显著高于仅重度脓毒症患者（中位数，488 pg/mL）和机械通气对照组（中位数，525 pg/mL），其中重度脓毒症患者（中位数，2951 pg/mL）或无重度脓毒症患者（中位数，3761 pg/mL）。血清肌酐水平与急性肺损伤/急性呼吸窘迫综合征的严重程度相关，并随时间降低，但与预后无关。较低的基线血浆sodium与局灶性丧失通气的基础上，计算机断层扫描肺morphology.Conclusions：sodium水平升高，在急性肺损伤/急性呼吸窘迫综合征，无论是否存在严重的败血症。急性呼吸窘迫综合征患者的血浆sodium水平与临床和影像学严重程度相关，并随时间推移而下降，表明肺泡上皮损伤的解决。进一步的研究是必要的，以测试这种生物标志物在管理这些患者的临床效用，并更好地了解其与肺形态在急性肺损伤/急性呼吸窘迫综合征的关系。(Crit Care Med 2011; 39：480-488）
Objectives: Levels of the soluble form of the receptor for advanced glycation end products (sRAGE) are elevated during acute lung injury. However, it is not known whether this increase is linked to its involvement in alveolar epithelium injury or in systemic inflammation. Whether sRAGE is a marker of acute lung injury and acute respiratory distress syndrome, regardless of associated severe sepsis or septic shock, remains unknown in the intensive care unit setting.Design: Prospective, observational, clinical study.Setting: Intensive care unit of an academic medical center.Patients: A total of 64 consecutive subjects, divided into four groups: acute lung injury/acute respiratory distress syndrome (n = 15); acute lung injury/acute respiratory distress syndrome plus severe sepsis/septic shock (n = 18); severe sepsis/septic shock (n = 16); and mechanically ventilated controls (n = 15).Interventions: None.Measurements and Main Results: Plasma sRAGE levels were measured at baseline and on days 3, 6, and 28 (or at intensive care unit discharge, whichever occurred first). Baseline plasma levels of sRAGE were significantly higher in patients with acute lung injury/acute respiratory distress syndrome, with (median, 2951 pg/mL) or without (median, 3761 pg/mL) severe sepsis, than in patients with severe sepsis (median, 488 pg/mL) only and in mechanically ventilated controls (median, 525 pg/mL). Levels of sRAGE were correlated with acute lung injury/acute respiratory distress syndrome severity and decreased over time but were not associated with outcome. Lower baseline plasma sRAGE was associated with focal loss of aeration based on computed tomography lung morphology.Conclusions: sRAGE levels were elevated during acute lung injury/acute respiratory distress syndrome, regardless of the presence or absence of severe sepsis. The plasma level of sRAGE was correlated with clinical and radiographic severity in acute respiratory distress syndrome patients and decreased over time, suggesting resolution of the injury to the alveolar epithelium. Further study is warranted to test the clinical utility of this biomarker in managing such patients and to better understand its relationship with lung morphology during acute lung injury/acute respiratory distress syndrome. (Crit Care Med 2011; 39: 480-488)