血浆可溶性血管内皮生长因子受体1在重症肺炎患者中的诊断与预测价值DOI：10.7504/nk2016010203屮图分类号：R587.1文献标识码：A摘要：目的探讨血浆可溶性血管内皮生长因子受体1(sFLT-1)在重症肺炎患者屮的检测水平变化及预测价值。方法选取2013年10月-2016年4月入住我院RICU的重症肺炎患者60例(A组)、重症肺炎合并感染性休克组60例(B组)、重症肺炎合并MODS组60例(C组)，选取入住呼吸科的普通肺炎患者60例作为对照组(D组)。比较各组患者入院第ld、3d、7d以及存活组和死亡组sFlt-1水平变化，分析血浆sFLT-1在重症肺炎屮的预测价值及与APACHEII评分的相关性。结果A、B、C3组的PCT和APACHEII评分有显著差异(P均<0.01)。血浆SFLT-1水平在4组患者间有显著差异，A、B、C3组第7d明显低于第Id(P<0.05)o重症肺炎死亡组sFLT-1水平显著高于存活组(637.6±222.0ng?L-lvs354.9±144.6ng?L-l,P<0.01)。重症肺炎sFLT-1水平和APACHEII评分具有很强的相关性(r=0.647,P<0.001)。sFLT-1预测重症肺炎和28d死亡率的敏感度及特异度分别为77.8%、75.0%和69.7%、80.1%,AUC分另IJ为0.787(95%CI：72.6%〜84.8%，P<0.001)和0.775(95%CI:70.5%~84.5%,P<0.001)o结论早期检测血浆sFLT-1水平可以预测重症肺炎和28天病死率。关键词：血浆SFLT-1;重症肺炎；预测价值Diagnosisandpredictivevalueofsolublevascularendothelialgrowthfactorreceptor-1inseverepneumoniaGAOYan-qiul,ZHANGHua2,LIShuang-fengl,SUNGuang-xinl,RENYing-jiel(AffiliatedZhengzhouCentralHospitalofZhengzhouUniversity，Zhengzhou450007,China；1.RespiratoryIntensiveCareUnit2.DepartmentofRespiratoryMedicine)[Abstract]ObjectiveToexplorethediagnosisandpredictiveclinicalvalueofsolublevascularendothelialgrowthfactorreceptor-1(sFLT-1)inseverepneumonia.Method60patients(groupA)withseverepneumonia,60patients(groupB)withseverepneumonia-relatedsepticshockand60patients(groupC)withseverepneumonia-relatedMODSinourRICUwereadmittedfromOctober2013toApril2016inthestudy.60casesofcommoncommunity-acquiredpneumoniaindepartmentofrespiratorymedicinewereincludedforcomparison(groupD).PlasmalevelsofsFLT-1weremeasuredat1st,3stand7strespectively.TheassociationsFLT-1withAPACHEIIscoresandpredictivevalueofsFLT-1forseverepneumoniawereanalyzed.ResultsThedifferenceswerestatisticallysignificantforthelevelsofserumPCTandAPACHEIIscoresamongthreegroups(P<0.01).ThereweresignificantdifferencesforplasmalevelofsFLT-1amongfourgroups(P<0.01).SFLT-1waslowerobviouslyon7stthan1stforgroupA,groupBandgroupC(P<0.05).Non-survivorsofseverepneumoniahadsignificantlyhigherplasmasFLT-1levelsthansurvivors(637.6±222.0ng?L-lvs354.9±144.6ng?L-l,P<0.01).PlasmasFLT-1levelscorrelatedwiththeAPACHEIIscores(r=0.647,P<0.001).SFLT-1wasusedfordiagnosisofseverepneumoniaandpredictthemortalityfor28d，thesensitivityandthespecificitywas77.8%,75.0%and69.7%,80.1%,respectively.AUCwas0.787(95%CI：72.6%〜84.8%,P<0.001)and0.775(95%CI：70.5%〜84.5%,P<0.001),respectively.ConclusionEarlymonitoringofplasmasFLT-1levelscandetermineandpredictseverepneumoniaandmortalityfor28d.【Keywords]serumsolublevascularendothelialgrowthfactorreceptor1；serevepneumonia；Predictivevalue重症肺炎(Severepneumonia,SP)是呼吸系统常见的急危重症，SP的病理基础是感染引发的一系列炎症反应、促炎因子释放、血液动力学改变、即患者血液中内毒素水平升高和失控的全身炎症反应导致多器官衰竭[1】。SP在国内外的死亡率分别高达50%[2]和45%-53%[3]o严重时可演变为全身感染，严重脓毒症，感炎性休克，多器官功能障碍练合征（multipleorgansdysfunctionsyndrome,MODS）。早期发现可靠的临床生物标志物评估病情严重程度，用以指导临床策略的选择是降低SP病死率的关键。WBC对感染而...
