患有急性呼吸困扰综合征的患者的亚表型,接受高流氧治疗
Pierre-Louis Blot1,2, Benjamin G Chousterman1,2, Manel Santafè3
1Département d'anesthésie-Réanimation, Hôpital Lariboisière, Paris, France.
Critical care (London, England)
|November 2, 2023
概括
在接受高流量鼻氧 (HFNO) 治疗的患者中,确定了两种急性呼吸困扰综合征 (ARDS) 亚表型. 超炎性亚表型的结果更差,这表明有针对性的临床试验丰富的潜力.
科学领域:
- 临界护理医学 临界护理医学
- 肺部病理学 肺部病理学
- 生物标志物发现发现
背景情况:
- 急性呼吸困扰综合征 (ARDS) 亚现象表现出不同的临床结果和治疗反应.
- 在接受高流量鼻氧 (HFNO) 的ARDS患者中,亚表型特征仍未得到充分研究.
研究的目的:
- 用HFNO.治疗的ARDS群体中识别出不同的生物学亚现象.
- 为了研究这些HFNO处理的ARDS亚表型之间的临床和生物差异.
主要方法:
- 一项前性观察性研究的二次分析,涉及使用HFNO的ARDS患者.
- 使用等离子体炎症和肺损伤生物标志物 (IL-6,IL-8,IL-33,sST2,RAGE,SP-D,Ang-2) 和二碳酸盐进行K-平均集群分析.
- 使用后勤回归和AUROC分析开发和验证高流量ARDS炎症亚表型 (HAIS) 评分.
主要成果:
- 确定了两个亚现象:超炎症 (n=17) 和低炎症 (n=24).
- 超炎症组的60天死亡率 (47%对8.3%) 和ICU停留时间明显更高.
- 来自IL-8和sST2的HAIS得分有效区分了亚表型 (AUROC 0.96),得分≥7.45预测了超炎症类型.
结论:
- 接受HFNO治疗的ARDS患者包括不同的生物亚表型,具有相似的基线特征,但预后不同.
- 超炎性亚表型与不良结果有关.
- 该HAIS得分显示了确定高炎症ARDS患者临床试验丰富的希望.
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