CA-125对ICU机械通气患者拔管后发生呼吸衰竭诊断的预测价值

Predictive Value of CA-125 for the Diagnosis of Post-Extubation Respiratory Failure in Mechanically Ventilated ICU Patients

摘要: 目的：评估CA-125对ICU机械通气患者在拔管后发生呼吸衰竭的诊断和预测价值。方法：纳入2024年8月至2025年7月在济宁市第一人民医院ICU住院的机械通气患者164例。根据撤机结果将患者分为撤机成功组(n = 134)和撤机失败组(n = 30)，比较两组的临床资料。采用多因素Logistic回归分析探讨成人ICU机械通气患者在撤机后出现呼吸衰竭的影响因素。采用ROC曲线评估CA-125及其正常值范围对成人ICU机械通气患者撤机后出现呼吸衰竭的预测价值。此外，以CA-125为分界指标，将患者分为CA-125 < 42.25组(n = 113)和CA-125 ≥ 42.25组(n = 51)，比较不同CA-125水平患者的机械通气时间和住院时间。结果：撤机成功组入ICU时的APACHEII评分、SOFA评分、CA-125水平及RSBI均低于撤机失败组(P < 0.05)。多因素Logistic回归分析结果显示，通过SBT试验后进行拔管时的CA-125水平是成人ICU机械通气患者撤机后出现呼吸衰竭的独立影响因素(P < 0.05)。ROC曲线分析结果显示，通过SBT试验后进行拔管时CA-125预测成人ICU机械通气患者撤机后出现呼吸衰竭的AUC为0.752 [95% CI (0.628, 0.862)]，对应Youden指数最大的截断值为42.25 UI/ml，灵敏度为0.767，特异度为0.784。将CA-125固定为35.00 UI/ml时，其预测成人ICU机械通气患者撤机后出现呼吸衰竭的AUC为0.743 [95% CI (0.658, 0.823)]，灵敏度为0.800，特异度为0.687。按CA-125分层比较，CA-125 < 42.25组的机械通气时间和住院时间均长于CA-125 ≥ 42.25组，差异具有统计学意义(P < 0.05)。结论：CA-125对成人ICU机械通气患者撤机后出现呼吸衰竭有一定预测效能。

Abstract: Objective: To evaluate the diagnostic and predictive value of CA-125 for post-extubation respiratory failure in mechanically ventilated ICU patients. Methods: We enrolled 164 mechanically ventilated patients admitted to the ICU of Jining First People’s Hospital from August 2024 to July 2025. Based on weaning outcomes, patients were classified into a weaning-success group (n = 134) and a weaning-failure group (n = 30), and clinical characteristics were compared between groups. Multivariable logistic regression was used to examine factors associated with post-weaning respiratory failure in adult ICU patients receiving mechanical ventilation. Receiver operating characteristic (ROC) curves were applied to assess the predictive value of CA-125 and its normal reference range for post-weaning respiratory failure in this population. In addition, using CA-125 as the stratification threshold, patients were divided into a CA-125 < 42.25 group (n = 113) and a CA-125 ≥ 42.25 group (n = 51), and mechanical ventilation duration and hospital length of stay were compared between the two groups. Results: At ICU admission, the weaning-success group had lower APACHE II scores, SOFA scores, CA-125 levels, and RSBI values than the weaning-failure group (P < 0.05). In multivariable logistic regression, the CA-125 level at the time of extubation following a successful spontaneous breathing trial (SBT) was an independent factor associated with post-weaning respiratory failure in mechanically ventilated adult ICU patients (P < 0.05). Receiver operating characteristic (ROC) analysis showed that CA-125 measured at extubation after SBT predicted post-extubation respiratory failure with an AUC of 0.752 (95% CI, 0.628~0.862); the cutoff corresponding to the maximal Youden index was 42.25 U/mL, with a sensitivity of 0.767 and a specificity of 0.784. Using a fixed CA-125 threshold of 35.00 U/mL yielded an AUC of 0.743 (95% CI, 0.658~0.823), with a sensitivity of 0.800 and a specificity of 0.687. When stratified by CA-125, patients with CA-125 < 42.25 had longer durations of mechanical ventilation and hospital stay than those with CA-125 ≥ 42.25 (P < 0.05). Conclusion: CA-125 demonstrates predictive utility for identifying post-extubation respiratory failure among mechanically ventilated adult ICU patients.