血浆PAD4、CCL19在重症肺炎并发ARDS患者中的表达及临床意义OA

Objective To investigate the expression and clinical significance of plasma peptidyl arginine deiminase 4(PAD4)and C-C motif chemokine ligand 19(CCL19)in patients with severe pneumonia(SP)complicated by acute respiratory distress syndrome(ARDS).Methods A total of 100 patients with SP complicated by ARDS(SP+ARDS group)and 100 pa-tients with SP alone(SP group)admitted to the Department of Respiratory and Critical Care Medicine of Affiliated Hospital of Inner Mongolia Medical University from January 2020 to December 2024 were prospectively enrolled in a 1∶1 ratio.Plasma PAD4 and CCL19 levels were measured by enzyme-linked immunosorbent assay.Based on oxygenation index,SP+ARDS pa-tients were further divided into mild(n=30),moderate(n=36),and severe(n=34)ARDS subgroups.Spearman correlation analysis was used to evaluate the association between PAD4,CCL19 levels and oxygenation index.Patients were also classi-fied into survival and death groups based on 28-day outcomes.Multivariate Logistic regression was performed to analyze fac-tors affecting prognosis.Receiver operating characteristic(ROC)curves were used to assess the predictive value of plasma PAD4 and CCL19 levels for prognosis.Results Compared with the SP group,plasma PAD4 and CCL19 levels were significantly higher in the SP+ARDS group(t/P=14.368/＜0.001,17.701/＜0.001).In SP patients with ARDS,plasma PAD4 and CCL19 lev-els increased progressively from mild to moderate to severe subgroups(F/P=146.875/＜0.001,166.125/＜0.001).Plasma PAD4 and CCL19 levels were negatively correlated with oxygenation index(rs/P=-0.752/＜0.001,-0.744/＜0.001).The 28-day mor-tality rate in SP patients with ARDS was 41.00％(41/100).Increased oxygenation index was an independent protective factor for poor prognosis,while elevated PAD4 and CCL19 levels were independent risk factors[OR(95％CI)=0.977(0.964-0.991),2.710(1.567-4.684),4.010(1.759-9.144)].The AUCs for plasma PAD4,CCL19,and their combination in predicting poor prognosis were 0.814,0.795,and 0.909,respectively;the combined model outperformed either biomarker alone(Z/P=2.865/0.004,2.819/0.005).Conclusion Elevated plasma PAD4 and CCL19 levels in SP patients with ARDS are closely associated with greater disease severity and higher mortality.The combination of plasma PAD4 and CCL19 levels provides superior pre-dictive value for prognosis compared with either marker alone.