-
支气管扩张合并支气管哮喘是呼吸系统疾病中一种比较特殊的慢性气道炎症,不仅仅可以表现为支气管扩张的慢性咳嗽、咳痰、咯血的临床表现,还可以表现为哮喘的症状,容易出现漏诊,可能是因为病人炎症反应较重时咳嗽、咳痰症状较明显而哮喘症状不典型,易出现哮喘的漏诊,当病人出现哮喘急性发作时若同时伴有咳嗽、咳痰,往往被认为合并感染,易出现支气管扩张的漏诊[1-2]。气管扩张并哮喘发病机制目前尚未完全明确,两种疾病临床表现复杂,症状较单纯的支气管扩张或支气管哮喘重,治疗难度大,住院时间长,而早期诊断尤为重要[3]。嗜酸性粒细胞(EOS)被认为是引起支气管哮喘黏膜损伤的重要炎症细胞,在哮喘病人疾病进展中起着重要作用,哮喘与EOS浸润气道上皮及气道的高反应性所致的气道重塑有关[4-5]。干扰素-γ(IFN-γ)是主要由T细胞分泌的细胞因子,具有抑制炎症因子释放、减轻气道过敏性炎症的作用[6]。本研究旨在探讨外周血EOS百分比(EOS%)、IFN-γ对支气管扩张合并支气管哮喘的诊断价值。现作报道。
-
3组病人性别、年龄、体质量指数(BMI)、WBC差异均无统计学意义(P>0.05),A组、B组病人EOS%明显高于C组,A组病人IFN-γ明显低于B组、C组(P < 0.01)(见表 1)。
分组 n 男 女 年龄/岁 病程/月 BMI/(kg/m2) PO2/mmHg PCO2/mmHg WBC/(×109) CRP/(mg/L) PCT/(ng/mL) EOS% IFN-γ/(ng/L) A组 48 21 27 64.25±4.15 24.29±2.79 20.88±3.31 58.33±0.97 51.68±0.94 14.78±2.16 48.45±4.47 10.67±1.05 5.36±0.78 19.82±5.14 B组 60 26 34 63.07±5.42 21.03±2.77 21.03±2.77 59.05±0.68 52.13±0.79 13.90±2.89 49.16±5.78 9.77±1.57 5.27±0.54 24.82±4.79** C组 57 27 30 64.18±5.32 23.97±2.50 20.95±2.25 58.90±0.69 51.80±0.58 14.68±1.98 50.78±4.14 10.56±2.21 1.17±0.52**## 29.57±3.15**## F — 0.23△ 0.98 25.39 0.04 12.30 5.03 2.29 3.21 4.69 850.22 63.76 P — >0.05 >0.05 < 0.01 >0.05 < 0.01 < 0.01 >0.05 < 0.05 < 0.05 < 0.01 < 0.01 MS组内 — — 25.470 7.213 7.723 0.606 0.600 5.751 23.889 2.906 0.376 19.451 t检验:与A组比较**P < 0.01;与B组比较##P < 0.01。△示χ2值 表 1 3组病人临床资料比较(x±s)
-
以支气管合并哮喘为自变量(是赋值为1,否赋值为0),IFN-γ、EOS%为因变量进行logistic回归分析,得到回归方程为Logit(P) =1.782+0.223 EOS% + 0.456 IFN-γ,模型中概率值变量pre-1 = 1/[1+exp(-Logit(P)]。并根据logistic回归模型中的概率值pre-1拟合联合ROC曲线绘制ROC曲线,结果显示EOS%诊断支气管扩张合并哮喘ROC曲线下面积(AUC)为0.633,95%CI:0.566~0.700,截断值为4.35%,敏感性为0.684,特异性为0.621;IFN-γ诊断支气管扩张合并哮喘截断值为33.56 ng/L,AUC为0.603,95%CI:0.533~0.672,敏感性为0.614,特异性为0.661;联合诊断AUC: 0.744, 敏感性为0.754,95%CI:0.681~0.807,特异性为0.601(见表 2)。
检验变量 敏感性 特异性 阳性预测值 阴性预测值 约登指数 AUC 95%CI IFN-γ 0.614(30/48) 0.661(78/117) 0.435(30/69) 0.813(78/96) 0.275 0.603 0.533~0.672 EOS% 0.684(33/48) 0.621(73/117) 0.429(33/77) 0.830(73/88) 0.305 0.633 0.566~0.700 联合诊断 0.754(37/48) 0.601(70/117) 0.440(37/84) 0.864(70/81) 0.355 0.744 0.681~0.807 表 2 EOS%、IFN-γ诊断支气管扩张合并哮喘的ROC曲线分析
嗜酸性粒细胞百分比和干扰素-γ用于支气管扩张伴支气管哮喘的诊断效能分析
Analysis of the diagnostic efficacy of eosinophil percentage and interferon-γ in bronchiectasis with asthma
-
摘要:
目的探讨嗜酸性粒细胞百分比(EOS%)和干扰素-γ(IFN-γ)对支气管扩张伴支气管哮喘的诊断价值。 方法选择支气管哮喘或者支气管扩张病人共165例,其中支气管扩张合并哮喘为A组48例,单纯哮喘为B组60例,单纯支气管扩张为C组57例。收集病人的临床资料,检测白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、氧分压(PO2)、二氧化碳分压(PCO2)、EOS%和IFN-γ的水平,运用logistic回归拟合IFN-γ、EOS%联合诊断模型并绘制ROC曲线评估诊断价值,采用Hanley-McNeil方法比较ROC曲线下面积。 结果A组、B组病人EOS%明显高于C组(P < 0.01),A组、B组病人EOS%差异无统计学意义(P>0.05),A组病人IFN-γ低于B组、C组(P < 0.01)。EOS%诊断支气管扩张合并哮喘的敏感性为0.684,特异性为0.621;IFN-γ诊断支气管扩张合并哮喘的敏感性为0.614,特异性为0.661;IFN-γ联合EOS%诊断支气管扩张合并哮喘的敏感性为0.754,特异性为0.601。 结论EOS%联合IFN-γ诊断支气管扩张合并哮喘的敏感性和特异性均较高,诊断价值较高。 Abstract:ObjectiveTo investigate the diagnostic value of eosinophil percentage(EOS%) and interferon-γ(IFN-γ) in bronchiectasis with asthma. MethodsA total of 165 patients with asthma or bronchiectasis were selected, including 48 patients with bronchiectasis combined with asthma in group A, 60 patients with asthma alone in group B, and 57 patients with bronchiectasis alone in group C.The clinical data of patients were collected, WBC, CRP, PCT, PO2, pCO2, EOS% and IFN-γ levels were measured and analyzed.Logistic regression was used to fit the IFN-γ and EOS% joint diagnosis model and draw the ROC curve to evaluate the diagnostic value.The area under the ROC curve was compared by Hanley-McNeil method. ResultsEOS% in group A and group B was significantly higher than that in group C(P < 0.01), and there was no significant difference in EOS% between group A and group B(P>0.05).IFN-γ in group A was significantly lower than that in group B and group C(P < 0.01).The sensitivity of EOS% in the diagnosis of bronchiectasis with asthma was 0.684, the specificity was 0.621;the sensitivity of IFN-γ in the diagnosis of bronchiectasis with asthma was 0.614, the specificity was 0.661.The sensitivity and specificity of IFN-γ combined with EOS% in the diagnosis of bronchiectasis with asthma were 0.754 and 0.601, respectively. ConclusionsThe sensitivity and specificity of EOS% combined with IFN-γ in the diagnosis of bronchiectasis combined with asthma are high, which has high diagnosis value. -
Key words:
- bronchiectasis /
- asthma /
- eosinophil percentage /
- interferon-γ
-
表 1 3组病人临床资料比较(x±s)
分组 n 男 女 年龄/岁 病程/月 BMI/(kg/m2) PO2/mmHg PCO2/mmHg WBC/(×109) CRP/(mg/L) PCT/(ng/mL) EOS% IFN-γ/(ng/L) A组 48 21 27 64.25±4.15 24.29±2.79 20.88±3.31 58.33±0.97 51.68±0.94 14.78±2.16 48.45±4.47 10.67±1.05 5.36±0.78 19.82±5.14 B组 60 26 34 63.07±5.42 21.03±2.77 21.03±2.77 59.05±0.68 52.13±0.79 13.90±2.89 49.16±5.78 9.77±1.57 5.27±0.54 24.82±4.79** C组 57 27 30 64.18±5.32 23.97±2.50 20.95±2.25 58.90±0.69 51.80±0.58 14.68±1.98 50.78±4.14 10.56±2.21 1.17±0.52**## 29.57±3.15**## F — 0.23△ 0.98 25.39 0.04 12.30 5.03 2.29 3.21 4.69 850.22 63.76 P — >0.05 >0.05 < 0.01 >0.05 < 0.01 < 0.01 >0.05 < 0.05 < 0.05 < 0.01 < 0.01 MS组内 — — 25.470 7.213 7.723 0.606 0.600 5.751 23.889 2.906 0.376 19.451 t检验:与A组比较**P < 0.01;与B组比较##P < 0.01。△示χ2值 表 2 EOS%、IFN-γ诊断支气管扩张合并哮喘的ROC曲线分析
检验变量 敏感性 特异性 阳性预测值 阴性预测值 约登指数 AUC 95%CI IFN-γ 0.614(30/48) 0.661(78/117) 0.435(30/69) 0.813(78/96) 0.275 0.603 0.533~0.672 EOS% 0.684(33/48) 0.621(73/117) 0.429(33/77) 0.830(73/88) 0.305 0.633 0.566~0.700 联合诊断 0.754(37/48) 0.601(70/117) 0.440(37/84) 0.864(70/81) 0.355 0.744 0.681~0.807 -
[1] TIOTIU A, MARTINET Y, JANKOWSKI R, et al. Gamma globulin replacement therapy in uncontrolled, severe asthma associated with humoral immunodeficiency: a series of five case reports[J]. J Asthma, 2019, 56(1): 79. doi: 10.1080/02770903.2018.1426768 [2] PAINE NJ, JOSEPH MF, BACON SL, et al. Association between depression, lung function, and inflammatory markers in patients with asthma and occupational asthma[J]. J Occup Environ Med, 2019, 61(6): 453. doi: 10.1097/JOM.0000000000001562 [3] NEOPHYTOU AM, OH SS, WHITE MJ, et al. Secondhand smoke exposure and asthma outcomes among African-American and Latino children with asthma[J]. Thorax, 2018, 73(11): 1041. doi: 10.1136/thoraxjnl-2017-211383 [4] GAI XY, ZHANG LJ, CHANG C, et al. Metabolomic analysis of serum glycerophospholipid levels in eosinophilic and neutrophilic asthma[J]. Biomed Environ Sci, 2019, 32(2): 96. [5] MAGLIONE M, AKSAMIT T, SANTAMARIA F. Paediatric and adult bronchiectasis: Specific management with coexisting asthma, COPD, rheumatological disease and inflammatory bowel disease[J]. Respirology, 2019, 24(11): 143. [6] KIM DH, SOHN JH, PARK HJ, et al. CpG Oligodeoxynucleotide inhibits cockroach-induced asthma via induction of IFN-γ+ Th1 Cells or Foxp3 Regulatory T Cells in the lung[J]. Allergy Asthma Immunol Res, 2016, 8(3): 264. doi: 10.4168/aair.2016.8.3.264 [7] 赵转华, 聂秀红. 支气管哮喘、慢性阻塞性肺疾病及哮喘-慢性阻塞性肺疾病重叠患者的气道阻力比较[J]. 国际呼吸杂志, 2018, 38(5): 321. doi: 10.3760/cma.j.issn.1673-436X.2018.05.001 [8] 王丹, 杨丹, 王小虎, 等. 支气管哮喘发病中的固有免疫机制[J]. 中华结核和呼吸杂志, 2018, 41(3): 228. doi: 10.3760/cma.j.issn.1001-0939.2018.03.016 [9] DUPIN C, MARCHAND-ADAM S, FAVELLE O, et al. Asthma and hypogammaglobulinemia: an asthma phenotype with low type 2 inflammation[J]. J Clin Immunol, 2016, 36(8): 1. [10] MUÑOZ G, DE GRACIA J, BUXÓ M, et al. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial[J]. Eur Respir J, 2018, 51(1): 1701926. doi: 10.1183/13993003.01926-2017 [11] 雒志明, 高赏, 任魁, 等. 支气管哮喘控制测试评分与外周血嗜酸性粒细胞计数的相关性研究[J]. 中国病案, 2018, 19(1): 91. doi: 10.3969/j.issn.1672-2566.2018.01.032 [12] BORTNICK A, CHERNOVA I, SPENCER SP, et al. No strict requirement for eosinophils for bone marrow plasma cell survival[J]. Eur J Immunol, 2018, 48(5): 815. doi: 10.1002/eji.201747229 [13] HU B, FENG X, WANG L, et al. 5-BDBD ameliorates an OVA-induced allergic asthma by the reduction of Th2 cytokines production[J]. Iran J Basic Med Sci, 2018, 21(4): 364. [14] 张海宁, 张晴, 张辉, 等. 支气管扩张症合并哮喘患者中IL-4和IFN-γ的表达水平及临床意义[J]. 临床肺科杂志, 2017, 22(3)573. doi: 10.3969/j.issn.1009-6663.2017.03.053 [15] 豆雪芹, 刘冬, 许西琳, 等. FeNO和外周血EOS%对支气管扩张合并哮喘的诊断价值[J]. 现代临床医学, 2018, 44(3): 183. [16] 涂智毅, 苏国秋, 郭晓珍, 等. 单纯支气哮喘和支气管哮喘合并支气管扩张症患者呼出气一氧化氮水平的差异比较[J]. 中国医药科学, 2019, 9(11): 26. doi: 10.3969/j.issn.2095-0616.2019.11.008