肺损伤预测评分联合血管生成素-2对肺部感染并发急性呼吸窘迫综合征的预测意义

doi:10.3877/cma.j.issn.1674-6902.2026.01.002

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (01) : 9 -14. doi: 10.3877/cma.j.issn.1674-6902.2026.01.002

论著

肺损伤预测评分联合血管生成素-2对肺部感染并发急性呼吸窘迫综合征的预测意义

梅春霞¹^,⁴, 冯霞¹, 邬海桥¹, 刘攀², 李昆霖³, 徐智⁴, 刘禹⁴^,^†(

)

¹400021　重庆，重庆市中医院呼吸与危重症学科
²400038　重庆，陆军（第三）军医大学第一附属医院呼吸与危重症学科
³400042　重庆，陆军（第三）军医大学陆军特色医学中心呼吸与危重症学科
⁴400037　重庆，陆军（第三）军医大学第二附属医院呼吸与危重症学科

收稿日期:2025-04-24 出版日期:2026-02-25
通信作者: 刘禹
基金资助:
国家自然科学基金项目资助(81370169, 81070053)

Predictive value of lung injury prediction score and Ang-2 for acute respiratory distress syndrome complicated by pulmonary infection

Chunxia Mei¹^,⁴, xia Feng¹, Haiqiao Wu¹, Pan Liu², Kunlin Li³, Zhi Xu⁴, Yu Liu⁴^,^†()

¹Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
²The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
³Army Medical Center of of Army Medical University, Chongqing 400042, China
⁴The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China

Received:2025-04-24 Published:2026-02-25
Corresponding author: Yu Liu

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引用本文：

梅春霞, 冯霞, 邬海桥, 刘攀, 李昆霖, 徐智, 刘禹. 肺损伤预测评分联合血管生成素-2对肺部感染并发急性呼吸窘迫综合征的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(01): 9-14.

Chunxia Mei, xia Feng, Haiqiao Wu, Pan Liu, Kunlin Li, Zhi Xu, Yu Liu. Predictive value of lung injury prediction score and Ang-2 for acute respiratory distress syndrome complicated by pulmonary infection[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 9-14.

目的

分析肺损伤预测评分(lung injury prediction score, LIPS)和血管生成素-2(angiopoietin-2, Ang-2)对肺部感染患者并发急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)的预测意义。

方法

纳入2013年3月至2022年5月陆军(第三)军医大学三所附属医院收治的90例肺部感染患者为对象，1周内发展为ARDS患者31例为观察组，未发展为ARDS患者59例为对照组。收集两组临床资料，包括年龄、性别、吸烟史、饮酒史、合并症(高血压、糖尿病、冠心病)、基础疾病(慢性阻塞性肺疾病、支气管扩张)、氧合指数、急性生理和慢性健康状况Ⅱ评分(acute physiology and chronic health evaluation Ⅱ，APACHEⅡ)、LIPS评分、ARDS发生情况及4种生物标志物的表达水平。绘制受试者工作特征曲线，比较LIPS评分、Ang-2及两者联合对肺部感染并发ARDS的预测意义。

结果

观察组氧合指数(167.88±74.99)mmHg低于对照组(265.94±96.91)mmHg(P<0.05)；观察组死亡14例(45.16%)，对照组死亡8例(13.56%)，观察组病死率高于对照组(P<0.05)。观察组APACHEⅡ评分(19.68±7.69)分、LIPS评分[6.50(5.50~7.50)]分、Ang-2[6.01(2.50~12.32)]ng/ml、IL- 8[54.43(3.9~118.11)]pg/ml高于对照组(15.81 ±6.25)分、[3.50(2.50~5.50)]分、[1.64(0.75~3.29)]ng/ml、[3.91(3.91~44.78)]pg/ml，差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示，LIPS评分和Ang-2为肺部感染并发ARDS的危险因素(P<0.05)。LIPS评分、Ang-2对肺部感染并发ARDS具有预测作用，但两者无统计学差异(AUR OC：0.82 vs. 0.77，P＝0.518)。LIPS和Ang-2联合后的曲线下面积为0.90(95%CI：0.82~0.96，P＝0.000)，较LIPS及Ang-2单独的曲线下面积有统计学意义(分别为Z＝2.652，P＝0.008；Z＝2.440，P＝0.015)；提示其对肺部感染并发ARDS的预测作用显著提高，阳性预测值为76.46%。

结论

LIPS和Ang-2可作为肺部感染并发ARDS的预测指标，两者联合能识别肺部感染并发ARDS高危风险。

关键词: 急性呼吸窘迫综合征, 肺部感染, 肺损伤预测评分, 血管生成素-2

Objective

To analyze the predictive value of the lung injury prediction score (LIPS) and angiopoietin-2 (Ang-2) for the development of acute respiratory distress syndrome (ARDS) in patients with pulmonary infection.

Methods

A total of 90 patients with pulmonary infection who were admitted to the Respiratory Intensive Care Unit (RICU) and Emergency Intensive Care Unit (EICU) of the Second, First, and Third Affiliated Hospitals of Army Medical University between March 2013 and May 2022 were enrolled. Thirty-one patients who developed ARDS within one week were assigned to the observation group, and fifty-nine patients who did not develop ARDS were assigned to the control group. Clinical data were collected from both groups, including age, sex, smoking and drinking history, comorbidities (hypertension, diabetes, coronary heart disease), underlying respiratory diseases(chronic obstructive pulmonary disease and bronchiectasis), oxygenation index, APACHE Ⅱ score, LIPS score, ARDS incidence, and the expression levels of four biomarkers. Receiver operating characteristic (ROC) curves were plotted to evaluate and compare the predictive value of LIPS, Ang-2, and their combination for ARDS in patients with pulmonary infection.

Results

The oxygenation index in the observation group was lower than that in the control group [(167.88±74.99)mmHg vs. (265.94±96.91) mmHg, P<0.05]. Fourteen patients (45.16%) died in the observation group compared with eight patients (13.56%) in the control group, with a significantly higher mortality in the observation group (P<0.05). The observation group also had higher APACHE Ⅱ scores (19.68±7.69 vs. 15.81 ±6.25), higher LIPS scores [6.50(5.50~7.50) vs. 3.50(2.50~5.50)], higher Ang-2 levels [6.01(2.50~12.32) vs. 1.64(0.75~3.29)ng/ml], and higher IL-8 levels [54.43(3.9~118.11) vs. 3.91(3.91~44.78)pg/ml], with statistically significant differences (P<0.05). Multivariate logistic regression analysis showed that LIPS and Ang-2 were independent risk factors for ARDS in patients with pulmonary infection (P<0.05). Both LIPS and Ang-2 had predictive value for ARDS, with no significant difference between the two (AUROC: 0.82 vs. 0.77, P=0.518). The combined use of LIPS and Ang-2 achieved a higher area under the curve (AUC=0.90, 95%CI: 0.82~0.96, P=0.000), which was significantly greater than that of either LIPS or Ang-2 alone (Z=2.65, P=0.008; Z=2.44, P=0.015, respectively). The combined model yielded a positive predictive value of 76.46%.

Conclusions

LIPS and Ang-2 can serve as predictive indicators for ARDS in patients with pulmonary infection. The combined application of LIPS and Ang-2 provides a identification of high-risk patients for developing ARDS.

Key words: Acute respiratory distress syndrome, Pulmonary Infection, Lung injury prediction score, Angiopoietin-2

表1 两组肺部感染患者APACHEⅡ评分、LIPS评分及生物标志物比较

临床特征	观察组(n＝31)	对照组(n＝59)	统计量	P值
APACHEⅡ评分(±s)	19.68±7.69	15.81 ±6.25	2.571	0.012
LIPS评分[M(Q₂₅，Q₇₅)]	6.50 5.50~7.50)	3.50(2.50~5.50)	4.973	0.000
Ang-2生物标志物[M(Q₂₅，Q₇₅)]	6.01(2.50~12.32)	1.64(0.75~3.29)	4.157	0.000
IL-8(pg/ml)	54.43(3.9~118.11)	3.91(3.91~44.78)	3.225	0.001
IL-6(pg/ml)	59.68(21.36~105.40)	32.98(5.46~89.74)	1.957	0.050
sES(ng/ml)	11.12(6.27~14.78)	7.62(5.38~12.80)	1.367	0.172

表1 两组肺部感染患者APACHEⅡ评分、LIPS评分及生物标志物比较

临床特征	观察组(n＝31)	对照组(n＝59)	统计量	P值
APACHEⅡ评分(±s)	19.68±7.69	15.81 ±6.25	2.571	0.012
LIPS评分[M(Q₂₅，Q₇₅)]	6.50 5.50~7.50)	3.50(2.50~5.50)	4.973	0.000
Ang-2生物标志物[M(Q₂₅，Q₇₅)]	6.01(2.50~12.32)	1.64(0.75~3.29)	4.157	0.000
IL-8(pg/ml)	54.43(3.9~118.11)	3.91(3.91~44.78)	3.225	0.001
IL-6(pg/ml)	59.68(21.36~105.40)	32.98(5.46~89.74)	1.957	0.050
sES(ng/ml)	11.12(6.27~14.78)	7.62(5.38~12.80)	1.367	0.172

表2 预测ARDS发生相关因素的多因素Logistics回归分析

指　标	OR	95%CI	χ²值	P值
APACHEⅡ评分	1.056	0.959~1.163	1.232	0.267
LIPS评分	2.281	1.506~3.455	15.169	0.000
Ang-2(ng/ml)	1.369	1.149~1.630	12.340	0.000
IL-8(pg/ml)	1.000	0.996~1.004	0.001	0.979

表2 预测ARDS发生相关因素的多因素Logistics回归分析

指　标	OR	95%CI	χ²值	P值
APACHEⅡ评分	1.056	0.959~1.163	1.232	0.267
LIPS评分	2.281	1.506~3.455	15.169	0.000
Ang-2(ng/ml)	1.369	1.149~1.630	12.340	0.000
IL-8(pg/ml)	1.000	0.996~1.004	0.001	0.979

图1 LIPS评分、Ang-2及两者联合对ARDS发生ROC曲线

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Predictive value of lung injury prediction score and Ang-2 for acute respiratory distress syndrome complicated by pulmonary infection

模态框（Modal）标题

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Predictive value of lung injury prediction score and Ang-2 for acute respiratory distress syndrome complicated by pulmonary infection