血清血管性血友病因子在急性肺损伤/急性呼吸窘迫综合征患者中表达的meta分析

doi:10.3969/j.issn.1004-583X.2024.10.002

摘要/Abstract

摘要：

目的系统评价血清血管性血友病因子(vWF)在急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者中的表达水平。方法检索中国知网、万方、维普、PubMed、Embase、Web of Science、Cochrane central register of controlled数据库,收集建库至2024年4月之前关于血清vWF在ALI/ARDS患者中表达的原始文献,依标准筛选文献,评价文献质量,运用STATA17和Revman5.3对收集的原始数据进行meta分析。结果在分析血清vWF表达与ALI/ARDS发病风险的关联时,共纳入6篇文献,包括260名ALI/ARDS患者,合并标准化均值差为[SMD=0.95,95%CI(0.64,1.25),P<0.01];在分析血清vWF表达对ALI/ARDS患者预后预测时,共纳入8篇文献,包括3198名ALI/ARDS患者,汇总比值比为[OR=1.61,95%CI(1.44,1.80),P<0.01]。结论血清vWF高表达与ALI/ARDS发病风险及预后预测具有显著相关性,作为一种便捷的检验方法,在临床实践中具有良好的应用价值。

关键词: 急性肺损伤, 呼吸窘迫综合征, 血管性血友病因子, Meta分析

Abstract:

Objective To systematically evaluate the serum von Willebrand factor (vWF) levels in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods Relevant literatures on the serum vWF levels in ALI/ARDS patients were searched in online databases, including the China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to April 2024. The studies were screened according to predefined criteria, and their quality was assessed. A meta-analysis was conducted using STATA17 and Revman5.3 on the collected original data. Results A total of 6 studies involving 260 ALI/ARDS patients were included in the present meta-analysis on exploring the correlation between serum vWF and risk of ALI/ARDS. The pooled standardized mean difference (SMD) was 0.95, with a 95% confidence interval (CI) of 0.64 to 1.25(P<0.01). A total of 8 studies involving 3,198 ALI/ARDS patients were included in the present meta-analysis on exploring the role of serum vWF in predicting the prognosis of ALI/ARDS. The pooled odds ratio (OR) was 1.61, with a 95%CI of 1.44 to 1.80(P<0.01). Conclusion The high serum vWF is significantly associated with the risk of ALI/ARDS and its prognosis. As a convenient testing method, measurement of serum vWF presents a high value for clinical practice.

Key words: acute lung injury, respiratory distress syndrome, von willebrand factor, meta-analysis

中图分类号:

冯雨慧, 邹兰兰, 李凡, 崔晨航, 乔俊英. 血清血管性血友病因子在急性肺损伤/急性呼吸窘迫综合征患者中表达的meta分析[J]. 临床荟萃, 2024, 39(10): 877-881.

Feng Yuhui, Zou Lanlan, Li Fan, Cui Chenhang, Qiao Junying. A meta-analysis of serum von Willebrand factor expression in patients with acute lung injury/acute respiratory distress syndrome[J]. Clinical Focus, 2024, 39(10): 877-881.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.10.002

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I10/877

图/表 4

参考文献 31

[1]	Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome[J]. Lancet, 2021, 398(10300): 622-637. doi: 10.1016/S0140-6736(21)00439-6 pmid: 34217425
[2]	田景霞, 许爱国. 重症肺炎诱发急性呼吸窘迫综合征患者血清Ang-1、vWF及APACHEⅡ的变化及意义[J]. 中国临床医生杂志, 2018, 46(12): 1429-1432.
[3]	Bos LDJ, Ware LB. Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes[J]. Lancet, 2022, 400(10358): 1145-1156. doi: 10.1016/S0140-6736(22)01485-4 pmid: 36070787
[4]	Mekontso Dessap A, Ware LB, Bagshaw SM. How could biomarkers of ARDS and AKI drive clinical strategies?[J]. Intensive Care Med, 2016, 42(5): 800-802. doi: 10.1007/s00134-016-4231-9 pmid: 26821714
[5]	Ware LB, Calfee CS. Biomarkers of ARDS: what's new?[J]. Intensive Care Med, 2016, 42(5): 797-799. doi: 10.1007/s00134-015-3973-0 pmid: 26174184
[6]	Bime C, Casanova N, Oita RC, et al. Development of a biomarker mortality risk model in acute respiratory distress syndrome[J]. Crit Care, 2019, 23(1): 410.
[7]	Ribes JA, Francis CW, Wagner DD. Fibrin induces release of von Willebrand factor from endothelial cells[J]. J Clin Invest, 1987, 79(1): 117-123. pmid: 3491837
[8]	Rubin DB, Wiener-Kronish JP, Murray JF, et al. Elevated von Willebrand factor antigen is an early plasma predictor of acute lung injury in nonpulmonary sepsis syndrome[J]. J Clin Invest, 1990, 86(2): 474-480. doi: 10.1172/JCI114733 pmid: 2384595
[9]	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605. doi: 10.1007/s10654-010-9491-z pmid: 20652370
[10]	Elfawy DM, Elkalek MA, Hamed E, et al. Evaluation of von Willebrand factor as a marker for early diagnosis of Acute Respiratory Distress Syndrome in comparison to Interleukin-6[J]. Ain-Shams J Anesthesiol, 2021, 13(1): 28.
[11]	Flori HR, Ware LB, Milet M, et al. Early elevation of plasma von Willebrand factor antigen in pediatric acute lung injury is associated with an increased risk of death and prolonged mechanical ventilation[J]. Pediatr Crit Care Med, 2007, 8(2): 96-101.
[12]	李锐, 曹书华, 王今达. 血管性假血友病因子和细胞间黏附分子-1在急性呼吸窘迫综合征中的动态变化及早期诊断的意义[J]. 中华急诊医学杂志, 2004, 13 (4): 251-253.
[13]	夏炎火, 林锡芳, 潘景业, 等. 血浆vWF:Ag、蛋白C活性在ALI/ARDS患者诊断和预后中的意义[J]. 医学研究杂志, 2013, 42(3): 89-93.
[14]	赵爽, 肖桂贤, 李宁, 等. 血浆vWF:Ag、蛋白C活性在ALI/ARDS患者诊断和预后中的意义[J]. 中国现代药物应用, 2020, 14(18): 63-65.
[15]	宗晓龙, 李真玉, 魏殿军, 等. 肺泡表面活性蛋白D、血管性血友病因子及白介素8对脓毒症诱发急性呼吸窘迫综合征的预测和预后意义[J]. 临床检验杂志, 2017, 35(2): 118-121.
[16]	Calfee CS, Ware LB, Glidden DV, et al. Use of risk reclassification with multiple biomarkers improves mortality prediction in acute lung injury[J]. Critical Care Medicine, 2011, 39(4): 711-717. doi: 10.1097/CCM.0b013e318207ec3c pmid: 21283009
[17]	Calfee CS, Gallagher D, Abbott J, et al. Plasma angiopoietin-2 in clinical acute lung injury: Prognostic and pathogenetic significance[J]. Crit Care Med, 2012, 40(6): 1731-177. doi: 10.1097/CCM.0b013e3182451c87 pmid: 22610178
[18]	Calfee CS, Janz DR, Bernard GR, et al. Distinct Molecular Phenotypes of Direct vs Indirect ARDS in Single-Center and Multicenter Studies[J]. Chest, 2015, 147(6): 1539-1548. doi: S0012-3692(15)37209-3 pmid: 26033126
[19]	Cartin-Ceba R, Hubmayr RD, Qin R, et al. Predictive value of plasma biomarkers for mortality and organ failure development in patients with acute respiratory distress syndrome[J]. J Crit Care, 2015, 30(1): 219.e1-e7.
[20]	El Basset Abo El Ezz AA, Abd El Hafez MA, El Amrousy DM, et al. The predictive value of Von Willebrand factor antigen plasma levels in children with acute lung injury[J]. Pediatr Pulmonol, 2017, 52(1): 91-97.
[21]	Ware LB, Eisner MD, Thompson BT, et al. Significance of von Willebrand factor in septic and nonseptic patients with acute lung injury[J]. Am J Respir Crit Care Med, 2004, 170(7): 766-772.
[22]	王少敏, 刘自刚. 血清chemerin、vWF与SP-D水平与急性呼吸窘迫综合征预后的相关性研究[J]. 国际检验医学杂志, 2019, 40(19): 2382-5.
[23]	Laffey JG, Pham T, Bellani G. Continued under-recognition of acute respiratory distress syndrome after the Berlin definition: What is the solution?[J]. Curr Opin Crit Care, 2017, 23(1): 10-17. doi: 10.1097/MCC.0000000000000381 pmid: 27922845
[24]	Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307(23): 2526-2533. doi: 10.1001/jama.2012.5669 pmid: 22797452
[25]	Matthay MA, Zemans RL, Zimmerman GA, et al. Acute respiratory distress syndrome[J]. Nat Rev Dis Primers, 2019, 5(1): 18. doi: 10.1038/s41572-019-0069-0 pmid: 30872586
[26]	Mokra D, Kosutova P. Biomarkers in acute lung injury[J]. Respir Physiol Neurobiol, 2015, 209: 52-58. doi: 10.1016/j.resp.2014.10.006 pmid: 25466727
[27]	Grunwell JR. So, you say you want a revolution? You tell me that it's evolution: Associating temporal changes in pediatric acute respiratory distress syndrome plasma biomarkers with lung injury severity[J]. Pediatr Crit Care Med, 2024, 25(1): 80-83.
[28]	Matsubara O, Tamura A, Ohdama S, et al. Alveolar basement membrane breaks down in diffuse alveolar damage: An immunohistochemical study[J]. Pathol Int, 1995, 45(7): 473-82. doi: 10.1111/j.1440-1827.1995.tb03488.x pmid: 7551006
[29]	Bime C, Camp SM, Casanova N, et al. The acute respiratory distress syndrome biomarker pipeline: Crippling gaps between discovery and clinical utility[J]. Transl Res, 2020, 226: 105-15. doi: 10.1016/j.trsl.2020.06.010 pmid: 32599095
[30]	Agrawal A, Matthay MA, Kangelaris KN, et al. Plasma angiopoietin-2 predicts the onset of acute lung injury in critically ill patients[J]. Am J Respir Crit Care Med, 2013, 187(7): 736-742.
[31]	张勤, 胡相悦. 血清KL-6、sTM、CC-16对脓毒症并发急性呼吸窘迫综合征患者预后的价值研究[J]. 临床急诊杂志, 2020, 21(9): 711-716.

研究作者	年份	年龄 (岁)	研究设计	诊断标准	例数		取样时间	NOS评分 (分)
研究作者	年份	年龄 (岁)	研究设计	诊断标准	试验组	对照组	取样时间	NOS评分 (分)
Elfawy等^[10]	2021	47.7±12.2	队列研究	柏林定义	39	21	入组时	8
Flori等^[11]	2007	5.9±6.0	队列研究	AECC	48	4	确诊24 h内	8
李锐等^[12]	2004	53.1±21.9	队列研究	昆明共识	20	15	入院48 h内	7
夏炎火等^[13]	2013	59.7±17.9	病例对照研究	昆明共识	49	21	入院24 h内	7
赵爽等^[14]	2020	55.2±6.7	病例对照研究	-	56	24	入院24 h内	7
宗晓龙等^[15]	2017	63.0±14.6	队列研究	柏林定义	48	40	入院24 h内	8

研究作者	年份	年龄 (岁)	研究设计	诊断标准	例数		取样时间	NOS评分 (分)
研究作者	年份	年龄 (岁)	研究设计	诊断标准	试验组	对照组	取样时间	NOS评分 (分)
Elfawy等^[10]	2021	47.7±12.2	队列研究	柏林定义	39	21	入组时	8
Flori等^[11]	2007	5.9±6.0	队列研究	AECC	48	4	确诊24 h内	8
李锐等^[12]	2004	53.1±21.9	队列研究	昆明共识	20	15	入院48 h内	7
夏炎火等^[13]	2013	59.7±17.9	病例对照研究	昆明共识	49	21	入院24 h内	7
赵爽等^[14]	2020	55.2±6.7	病例对照研究	-	56	24	入院24 h内	7
宗晓龙等^[15]	2017	63.0±14.6	队列研究	柏林定义	48	40	入院24 h内	8

研究作者	年份	年龄 (岁)	研究人群	研究设计	诊断标准	研究例数 (例)	取样时间	NOS评分 (分)
Flori等^[11]	2007	5.9±6.0	ALI/ARDS	队列研究	AECC	48	确诊24 h内	8
Calfee等^[16]	2011	50.0±16.0	ALI/ARDS	队列研究	AECC	547	分组前	9
Calfee等^[17]	2012	50.0±16.0	ALI/ARDS	队列研究	AECC	931	分组前	9
Calfee等^[18]	2015	51.0±16.0	ALI/ARDS	队列研究	AECC	853	分组前	9
Cartin-Ceba等^[19]	2015	62.6±6.0	ARDS	队列研究	AECC	100	确诊24 h内	8
El Ezz等^[20]	2017	4.9±2.9	ALI/ARDS	队列研究	AECC	40	入院24 h内	9
Ware等^[21]	2004	51.0±17.0	ALI/ARDS	队列研究	AECC	559	分组时	9
王少敏等^[22]	2019	49.1±1.8	ARDS	病例对照研究	柏林定义	120	分组后	8

研究作者	年份	年龄 (岁)	研究人群	研究设计	诊断标准	研究例数 (例)	取样时间	NOS评分 (分)
Flori等^[11]	2007	5.9±6.0	ALI/ARDS	队列研究	AECC	48	确诊24 h内	8
Calfee等^[16]	2011	50.0±16.0	ALI/ARDS	队列研究	AECC	547	分组前	9
Calfee等^[17]	2012	50.0±16.0	ALI/ARDS	队列研究	AECC	931	分组前	9
Calfee等^[18]	2015	51.0±16.0	ALI/ARDS	队列研究	AECC	853	分组前	9
Cartin-Ceba等^[19]	2015	62.6±6.0	ARDS	队列研究	AECC	100	确诊24 h内	8
El Ezz等^[20]	2017	4.9±2.9	ALI/ARDS	队列研究	AECC	40	入院24 h内	9
Ware等^[21]	2004	51.0±17.0	ALI/ARDS	队列研究	AECC	559	分组时	9
王少敏等^[22]	2019	49.1±1.8	ARDS	病例对照研究	柏林定义	120	分组后	8