内脏脂肪组织/皮下脂肪组织比值与急性呼吸窘迫综合征预后的相关性研究-现代医学

内脏脂肪组织/皮下脂肪组织比值与急性呼吸窘迫综合征预后的相关性研究

单位：内蒙古医科大学第三附属医院呼吸与危重症医学科, 内蒙古包头 014010

分类号：R563.8

出版年·卷·期（页码）：2022·50·第一期（9-14）

摘要：

目的：探讨内脏脂肪组织(VAT)/皮下脂肪组织(SAT)的比值与急性呼吸窘迫综合征(ARDS)患者预后的关系。方法：回顾性纳入了2019年3月至2020年3月期间就诊于本院的156例ARDS患者，采用腹部CT测量VAT和SAT并计算分析VAT/SAT。利用受试者工作特征(ROC)曲线计算VAT/SAT预测ARDS患者住院期间死亡的最佳临界值，并根据最佳临界值将患者分为高VAT/SAT组和低VAT/SAT组，比较2组患者的临床特征差异。采用多因素Logistic回归分析ARDS患者死亡的危险因素。结果：VAT/SAT预测ARDS的最佳临界值为3.15，与低VAT/SAT组(n=98)相比，高VAT/SAT组(n=58)患者男性比例、有吸烟史患者比例、住院死亡率、ICU住院时间升高，有饮酒史患者比例降低(P<0.05)。156例ARDS患者，48例患者死亡(死亡组)，总体住院死亡率为30.8%。死亡组患者VAT/SAT、APACHEⅡ评分、有吸烟史患者比例、ARDS严重程度均高于存活患者，死亡患者SAT、VAT低于存活患者，差异有统计学意义。多因素Logistic回归分析显示，VAT/SAT(OR：4.762；95%CI：2.305~9.839，P<0.001)、APACHE Ⅱ评分(OR：1.183；95%CI：1.111~1.261，P<0.001)、ARDS程度(OR：2.939;95%CI：1.191~7.252, P=0.019)是ARDS患者死亡独立影响因素。 结论：较高的VAT/SAT可预测ARDS患者预后可能更差。

Objective: To explore retrospectively the correlation between visceral adipose tissue(VAT), subcutaneous adipose tissue(SAT),the ratio of VAT to SAT(VAT/SAT), and the prognosis of patients with acute respiratory distress syndrome(ARDS). Methods: A retrospective study of 156 patients with ARDS from March 2019 to March 2020 was conducted. VAT and SAT were caculated by abdominal CT. The prognostic factors such as VAT, SAT, VAT/SAT were analyzed.Results: Compared with low VAT/SAT group(n=98), high VAT/SAT group(n=58) had higher male proportion, higher proportion of patients with smoking history, higher mortality rate, longer stay in ICU and lower proportion of patients with drinking history. Among 156 patients with ARDS, 48 died(death group), and the overall in-hospital mortality rate was 30.8%. VAT/SAT, APACHE Ⅱ score, the proportion of patients with smoking history and the severity of ARDS in the death group were higher than those in the survival group, while SAT and VAT in the death group was lower than that in the survival group, the difference was statistically significant. Multivariate regression analysis showed that VAT/SAT[(4.762(2.305-9.839)，P<0.001], APACHE Ⅱ[OR：1.183(1.111-1.261)，P<0.001)], ARDS severity[(OR：2.939(1.191-7.252)，P=0.019]were independent risk factors of ARDS patients. Conclusion: Higher VAT/SAT can contribute to adverse outcomes of patients with ARDS.

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