Development and practical use of predictive methods of adult respiratory distress syndrome in patients with sepsis

成人呼吸窘迫综合征（ARDS）可发展为各种疾病的并发症，包括败血症，但尚不可能确定哪些有风险的患者会发展为严重疾病。我们建立了一种比以前更快速、更简便的测定血清锰超氧化物歧化酶水平的方法，并研究了六种标记物在血液中顺序测定的能力，以预测败血症患者ARDS的发展。在败血症的初始诊断时（ARDS发生前6-24h）， 6例随后发生ARDS的患者血清锰超氧化物歧化酶浓度和过氧化氢酶活性均高于未发生ARDS的患者。这些抗氧化酶的变化与同时评估血清乳酸脱氢酶活性和因子VIII浓度具有相同的敏感性、特异性和效率，可以预测脓毒症患者ARDS的发展。相比之下，血清谷胱甘肽过氧化物酶活性和α - pi -弹性蛋白酶复合物浓度在脓毒症的初始诊断中，在随后发生ARDS的患者和未发生ARDS的患者之间没有差异，并且在预测ARDS的发展方面没有那么有效。测量锰超氧化物歧化酶，以及其他标志物，应该有助于识别ARDS最高风险患者，并允许前瞻性治疗。

Adult respiratory distress syndrome (ARDS) can develop as a complication of various disorders, including sepsis, but it has not been possible to identify which of the patients at risk will develop serious disorfer. We have established a more rapid and easy method to measure serum levels of manganese superoxide dismutase than before and investigated the ability of six markers, measured sequentially in blood, to predict development of ARDS in patients with sepsis.At the initial diagnosis of sepsis (6-24h before the development of ARDS), serum manganese superoxide dismutase concentration and catalase activity were higher in the 6 patients who subsequently developed ARDS than in patients who did not develop ARDS.These changes in antioxidant enzymes predicted the development of ARDS in septic patients with the same sensitivity, specificity, and efficiency as simultaneous assessments of serum lactate dehydrogenase activity and factor VIII concentration. By contrast, serum glutathione peroxidase activity and alpha Pi-elastase complex concentration did not differ at the initial diagnosis of sepsis between patients who did and did not subsequently develop ARDS,and were not as effective in predicting the development of ARDS.Measurement of manganese superoxide dismutase, in addition to the other markers, should facilitate identification of patients at highest risk of ARDS and allow prospective treatment.