Research Of The Serum Biomarkers In Pulmonary And Extrapulmonary Acute Respiratory Distress Syndrome

Objective:To observe the levels of serum angiopoietin-2?Ang-2?,pulmonary surfactant D?SP-D?,soluble receptor for advanced glycation end-products?sRAGE?and kerbs von lungren 6 antigen?KL-6?and clinical characteristics in patients with acute respiratory distress syndrome primarily from pulmonary diseases?ARDSp?and patients with acute respiratory distress syndrome primarily from extrapulmonary diseases?ARDSexp?and investigate the differences between ARDSp and ARDSexp and discuss the biomarkers that applied to ARDSp and ARDSexp respectively.Methods:49 eligible patients with ARDS were selected from Dept of Respiratory ICU,Dept of General ICU and Dept of Emergency ICU,the Second Affiliated Hospital of Nanchang University,during April 2015 and February 2016,including 29 males and20 females;they were divided into ARDSp group and ARDSexp group,referring to Gattinoni^[1]classification and observing the 28-day outcomes.19 cases came from healthy examination personnel in the same period in the Dept of Physical Examination,the Second Affiliated Hospital of Nanchang University as the control group including 12 males and 7 females.The collection of clinical data,Acute physiology and chronic health evaluation ? and lung injury score of all hospitalized patients were completed within the first 24 hours after diagnosis of ARDS,serum levels of Ang-2,SP-D,sRAGE,KL-6 in the second morning after diagnosis were determined by enzyme-linked immunosorbent assay?ELISA?and compared between each groups,correlation analysis were conducted between different indicators.Finally,the analysis of the relationship between the mentioned four biomarkers and the outcomes of each groups were conducted.Results:?1?The serum level of Ang-2 was significantly higher in the patients in the two ARDS groups than that in the people in control group,the serum level of Ang-2 was higher in the patients in ARDSexp group than those in ARDSp group,all the differences had statistical significance?P<0.05?;?2?The serum level of SP-D was significantly higher in the patients in the two ARDS groups than that in the people in control group,the serum level of SP-D was higher in the patients in ARDSp group than those in ARDSexp group,all the differences had statistical significance?P<0.05?;?3?The serum level of sRAGE was significantly higher in the patients in the two ARDS groups than the people in control group?P<0.05?,but there was no statistical difference between the patients in ARDSp group and ARDSexp group?P>0.05?;?4?The serum level of KL-6 in the patients in ARDSp group was significantly higher than that in the people in control group?P<0.05?,but there was no statistical difference between the ARDSp group and the ARDSexp group?P>0.05?and between the ARDSexp group and the control group?P>0.05?;?5?The serum level of Ang-2 and the APACHE? were significantly correlated both in the patients in ARDSp group and ARDSexp group?P<0.05?,the serum level of RAGE and the APACHE? were significantly correlated in the patients with ARDSp?P<0.05?;?6?The serum levels of SP-D,sRAGE and KL-6 of the non-survivors with ARDS were significantly higher than those of survivors?P<0.05?;?7?The serum levels of SP-D and KL-6 of the non-survivors in the ARDSp group were significantly higher than those of survivors in the same group?P<0.05?.Conclusion:?1?The serum levels of Ang-2?SP-D?sRAGE were significantly higher in the patients with ARDS,suggesting that those biomarkers may become serum biomarkers of ARDS;?2?The serum level of SP-D was significantly higher in the patients with ARDSp than that in the patients with ARDSexp,the serum level of Ang-2 was significantly lower in the patients with ARDSp than that in the patients with ARDSexp,the serum level of KL-6 was significantly higher in the patients with ARDSp,those above suggest that ARDSp may be characterized by early alveolar epithelial injury and ARDSexp may be characterized by early endothelial injury.Furthermore,SP-D and KL-6 may be the serum biomarkers of ARDSp,Ang-2 may be the biomarker of ARDSexp.?3?The serum level of Ang-2 was significantly positively correlated with the APACHE? in the patients with ARDS,which suggests the serum level of Ang-2 may reflect the illness severity early in ARDS;The serum level of sRAGE was significantly positively correlated with the APACHE? in the patients with ARDSp,which suggests that the serum level of sRAGE may reflect the illness severity early in ARDSp;?4?The serum levels of SP-D and KL-6 early in ARDSp patients may be associated with their poor outcomes.