血管生成素样蛋白4和Ⅱ型肺泡细胞表面抗原-6与急性呼吸窘迫综合征严重程度的关系及对预后的评估效能研究

摘要 目的：分析血管生成素样蛋白4(ANGPTL4)和Ⅱ型肺泡细胞表面抗原-6(KL-6)与急性呼吸窘迫综合征严重程度的关系及对预后的评估效能。方法：选择我院自2020年1月至2022年12月收治的120例急性呼吸窘迫综合征患者作为研究对象（观察组），根据氧合指数（PaO₂/FiO₂）分为轻度组、中度组和重度组；另选120例非急性呼吸窘迫综合征患者作为对照组。检测所有患者血清ANGPTL4和KL-6的表达水平，分析血清ANGPTL4和KL-6与APACHE Ⅱ评分、PaO₂/FiO₂的关系，使用受试者工作特征曲线（ROC）下面积（AUC）评价血清ANGPTL4联合KL-6对急性呼吸窘迫综合征预后的评估效能。结果：对比对照组，观察组血清ANGPTL4、KL-6的表达水平均明显升高（P＜0.05）；血清ANGPTL4、KL-6的表达水平在轻度组、中度组和重度组中差异有统计学意义，且急性呼吸窘迫综合征越严重，升高越明显（P＜0.05）；经Pearson相关性分析，急性呼吸窘迫综合征患者血清ANGPTL4、KL-6的表达水平与PaO₂/FiO₂呈负相关，与APACHE Ⅱ评分呈正相关（P＜0.05）；经ROC曲线分析，血清ANGPTL4联合KL-6预测急性呼吸窘迫综合征患者入院28d内死亡的敏感度为90.14%、特异度为65.74%，AUC为0.900。结论：血清ANGPTL4、KL-6表达水平升高与急性呼吸窘迫综合征严重程度增大密切相关，两者联合在患者预后评估中具有一定价值，可作为判断病情及预后的辅助指标。

The Relationship between Angiopoietin-like Protein 4 and Type II Alveolar Cell Surface Antigen 6 and the Severity of Acute Respiratory Distress Syndrome and the Efficacy of Evaluating the Prognosis

ABSTRACT Objective: To analyze the relationship between ANGPTL4 (ANGPTL4) and type II alveolar cell surface antigen-6 (KL-6) and the severity and prognosis of acute respiratory distress syndrome. Methods: 120 patients with acute respiratory distress syndrome admitted to our hospital from January 2020 to December 2022 were selected as study subjects (observation group), and divided into mild group, moderate group and severe group according to oxygenation index (PaO₂/FiO₂). Another 120 non-acute respiratory distress syndrome patients were selected as control group. The expression levels of serum ANGPTL4 and KL-6 in all patients were detected, and the relationship between serum ANGPTL4 and KL-6, APACHE Ⅱ score and PaO₂/FiO₂ was analyzed. The area under receiver operating characteristic curve (ROC) (AUC) was used to evaluate the prognostic efficacy of serum ANGPTL4 combined with KL-6 in acute respiratory distress syndrome. Results: Compared with control group, the expression levels of serum ANGPTL4 and KL-6 in observation group were significantly increased (P<0.05). The expression levels of ANGPTL4 and KL-6 in serum were significantly different among mild, moderate and severe groups(P<0.05), and the more severe acute respiratory distress syndrome was, the more obvious the increase was. By Pearson correlation analysis, the expression levels of serum ANGPTL4 and KL-6 in patients with acute respiratory distress syndrome were negatively correlated with PaO₂/FiO₂ (P<0.05), and positively correlated with APACHE Ⅱ score(P<0.05). ROC curve analysis showed that serum ANGPTL4 combined with KL-6 had a sensitivity of 90.14%, a specificity of 65.74% and an AUC of 0.900 in predicting death within 28 days after admission to hospital in patients with acute respiratory distress syndrome. Conclusion: The increase of serum ANGPTL4 and KL-6 expression levels is closely related to the increase of the severity of acute respiratory distress syndrome, the combination of ANGPTL4 and KL-6 has certain value in the prognosis assessment of patients, and can be used as an auxiliary indicator to judge the disease and prognosis.