GU Weili,ZHANG Chengliang,XU Zhihua*.The relationship between the receptor for advanced glycation end-products and the prognosis of ARDS patients[J].Journal of Xuzhou Medical University,2018,38(01):33-37.





The relationship between the receptor for advanced glycation
end-products and the prognosis of ARDS patients
GU Weili ZHANG Chengliang XU Zhihua*
Department of Intensive Care Unit, the Second Affiliated Hospital of Nantong University,
Nantong, Jiangsu 226001, China
acute respiratory distress syndrome receptor for advanced glycation end-products prognosis
 目的探讨晚期糖基化终末产物受体(RAGE)各亚型与急性呼吸窘迫综合征(ARDS)患者预后之间的关系。方法将我院重症医学科(ICU)收治的40例ARDS患者,根据患者28天病死率分为生存组和死亡组2个亚组,另选择同时期入住ICU的25例非ARDS进行机械通气的患者作为对照组。入院6 h内测定动脉血气分析计算氧合指数(PaO2/FiO2)。24 h内进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和Murray急性肺损伤评分。采用酶联免疫吸附试验(ELISA)检测可溶性RAGE(sRAGE)和内源分泌型RAGE(esRAGE)水平。结果与非ARDS机械通气患者相比,ARDS患者血浆sRAGE浓度水平显著增高,血浆esRAGE浓度水平下降(P<0.05);ARDS死亡组患者的血浆sRAGE浓度高于生存组患者(P<0.05)。单/多因素相关分析显示,只有血浆sRAGE是ARDS患者病死率的独立风险因素,且sRAGE血浆浓度水平与年龄、性别、心率、APACHEⅡ评分、Murray评分及esRAGE血浆浓度无关。结论血浆sRAGE浓度增高、esRAGE浓度下降有助于ARDS的临床诊断。血浆sRAGE浓度是ARDS患者病死率的独立风险因素,有可能成为一种能客观反映ARDS患者肺损伤程度和预后的生物学标记物。
ObjectiveTo investigate the relationship between the subtypes of the receptor for advanced glycation end-products (RAGE) and the prognosis of acute respiratory distress syndrome (ARDS) patients. MethodsA total of 40 patients who were diagnosed with ARDS and admitted into the intensive care unit (ICU) in our hospital were enrolled. They were divided into a survival subgroup and a non-survival subgroup, according to their mortality within 28 days. Meanwhile, another 25 non-ARDS patients under the mechanical ventilation were selected as a control group. Then, blood gas analysis was performed to calculate the oxygenation index (PaO2/FiO2) within 6 hours after admission. Also, the Acute Physiology and Chronic Health EvaluationⅡ(APACHE Ⅱ) score and Murray score were determined within 24 hours. The levels of soluble RAGE (sRAGE) and endogenous RAGE (esRAGE) were measured by ELISA. ResultsCompared with the non-ARDS patients under the mechanical ventilation, ARDS patients produced remarkably increased levels of plasma sRAGE and decreased levels of plasma esRAGE (P<0.05). For ARDS patients, the amount of sRAGE was significantly higher in the non-survival subgroup than that in survival group (P<0.05). According to the univariate and multivariate analysis, plasma sRAGE was the only independent risk factor for the prognosis of ARDS. Meanwhile, the plasma level of sRAGE was independent of age, gender, heart rate, APACHE II score, Murray score and the level of plasma esRAGE. ConclusionsIncreases in the level of plasma sRAGE and decreases in the level of plasma esRAGE can facilitate the clinical diagnosis of ARDS. The level of plasma sRAGE is an independent risk factor for ARDS patients, which may become a biological marker that can objectively reflect the degree of lung injury and predict the prognosis of ARDS patients.


[1]Mason C, Dooley N, Griffiths M. Acute respiratory distress syndrome [J].Clin Med (Lond), 2016,16(Suppl 6):s66-s70.
[2]Phua J, Badia JR, Adhikari NK, et al. Has mortality from acute respiratory distress syndrome decreased over time? A systematic review [J]. Am J Respir Crit Care Med, 2009,179(3):220-227.
[3]Kislinger T, Fu C, Huber B,  et al.N(epsilon)-(carboxymethyl)lysine adducts of proteins are ligands for receptor for advanced glycation end products that activate cell signaling pathways and modulate gene expression [J]. J Biol Chem, 1999,274(44):31740-31749.
[4]Lohwasser C,Neureiter D, Popov Y, et al.Role of the receptor for advanced glycation end products in hepatic fibrosis [J]. World J Gastroenterol, 2009,15(46):5789-5798.
[5]Uchida T, Shirasawa M, Ware LB, et al.Receptor for advanced glycation end-products is a marker of type I cell injury in acute lung injury [J]. Am J Respir   Crit Care Med, 2006,173(9):1008-1015.
[6]Briot R, Frank JA, Uchida T, et al.Elevated levels of the receptor for advanced glycation end products, a marker of alveolar epithelial type I cell injury, predict impaired alveolar fluid clearance in isolated perfused human lungs [J]. Chest, 2009,135(2):269-275.
[7]Mukherjee TK , Mukhopadhyay S, Hoidal JR.Implication of receptor for advanced glycation end product (RAGE) in pulmonary health and pathophysiology [J].Respir Physiol Neurobiol, 2008,162(3):210-215.
[8]Force ADT, Ranieri VM, Rubenfeld GD, et al.Acute respiratory distress syndrome: the Berlin Definition [J]. JAMA, 2012,307(23):2526-2533.
[9]Demling N , Ehrhardt C, Kasper M, et al.Promotion of cell adherence and spreading: a novel function of RAGE, the highly selective differentiation marker of human alveolar epithelial type I cells [J]. Cell Tissue Res, 2006,323(3):475-488.
[10]Aleshin A, Ananthakrishnan R, Li Q, et al.RAGE modulates myocardial injury consequent to LAD infarction via impact on JNK and STAT signaling in a murine model [J]. Am J Physiol Heart Circ Physiol, 2008,294(4):H1823-H1832.
[11]Sorci G, Riuzzi F, Giambanco I, et al.RAGE in tissue homeostasis, repair and regeneration [J].Biochim Biophys Acta, 2013,1833(1):101-109.
[12]Bierhaus A, Humpert PM, Morcos M, et al. Understanding RAGE, the receptor for advanced glycation end products [J]. J Mol Med (Berl), 2005,83(11):876-886.
[13]Sims GP, Rowe DC, Rietdijk ST, et al. HMGB1 and RAGE in inflammation and cancer[J]. Annu Rev Immunol, 2010,28:367-388.
[14]Jabaudon M, Blondonnet R, Roszyk L, et al. Soluble form of the receptor for advanced glycation end products is a marker of acute lung injury but not of severe sepsis in critically ill patients [J].Crit Care Med, 2011,39(3):480-488.
[15]Guo WA, Knight PR, Raghavendran K. The receptor for advanced glycation end products and acute lung injury/acute respiratory distress syndrome [J]. Intensive Care Med, 2012,38(10):1588-1598.
[16]Mrozek S, Jabaudon M, Jaber S, et al. Elevated plasma levels of sRAGEare associated with nonfocal CT-based lung imaging in patients with ARDS: A prospective multicenter study [J]. Chest, 2016,150(5):998-1007.
[17]Christaki E, Opal SM, Keith JC, et al. A monoclonal antibody against RAGE alters gene expression and is protective in experimental models of sepsis and pneumococcal pneumonia [J]. Shock, 2011,35(5):492-498.
[18]Zhang H, Tasaka S, Shiraishi Y, et al. Role of soluble receptor for advanced glycation end products on endotoxin-induced lung injury [J]. Am J Respir Crit Care Med, 2008,178(4):356-362.


 CHENG Shuli,LIU Caixia*.Effects of early high-volume hemofiltration on severe acute pancreatitis patients with respiratory distress syndrome[J].Journal of Xuzhou Medical University,2017,37(01):653.
 [J].Journal of Xuzhou Medical University,2002,22(01):189.
 [J].Journal of Xuzhou Medical University,2013,33(01):302.
 [J].Journal of Xuzhou Medical University,2016,36(01):127.
 [J].Journal of Xuzhou Medical University,2016,36(01):296.
 [J].Journal of Xuzhou Medical University,2019,39(01):235.
 [J].Journal of Xuzhou Medical University,2017,37(01):653.
 Application prospect of mesenchymal stem cells in acute respiratory distress syndrome and coronavirus disease 19[J].Journal of Xuzhou Medical University,2022,42(01):231.[doi:10.3969/j.issn.2096-3882.2022.03.014]
 [J].Journal of Xuzhou Medical University,2018,38(01):33.


更新日期/Last Update: 2018-04-12