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现如今,抗生素广泛应用于临床,但是社区获得性肺炎(CAP)仍然是威胁人类健康最常见感染性疾病之一,CAP好发于免疫力低下人群,随着我国人口老龄化加重,正严重威胁老年人的生命健康。CAP病死率居高不下,住院病人平均约10%,入住重症监护病房者高达40%左右[1]。导致发病率及病死率高的原因有社会人口老龄化、吸烟、伴有基础疾病和免疫功能低下、不恰当抗生素使用。以往,对于CAP临床诊断主要依靠症状、体征、白细胞(WBC)计数、痰培养、肺部影像学表现[2],部分检查可能耗时较长、特异性较差。肺炎严重指数(PSI)评分可用于预测CAP的预后[3],但评分较为复杂。肝素结合蛋白(HBP)是近年研究较多的新型炎症标志物,大量研究显示其指标与脓毒症严重程度呈正相关[4-5]。重症肺炎的病理特点是肺炎导致全身炎症反应综合征,本质上是重度脓毒症。本研究通过对CAP病人的HBP检测,观察HBP与CAP严重程度之间关系。
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高危组HBP、PCT水平高于中危、低危组,差异有统计学意义(P < 0.05),中危与低危组HBP、PCT差异无统计学意义(P>0.05)。与对照组进行比较,高危组、中危组、低危组HBP、PCT、WBC水平差异均有统计学意义(P < 0.05),而高危组与中危组、低危组WBC水平比较差异均无统计学意义(P>0.05)(见表 1)。
分组 n HBP/(ng/mL) PCT/(ng/mL) WBC/(×109/L) 高危组 47 187.05±48.96 8.73±2.25 16.82±4.42 中危组 43 16.80±5.34* 1.40±0.62* 16.20±5.25 低危组 25 13.49±4.87* 1.01±0.43* 12.34±3.45 对照组 42 5.34±1.50*#△ 0.30±0.08*#△ 7.20±1.35*#△ H — 24.72 14.73 12.70 P — < 0.01 < 0.05 < 0.05 H检验:与高危组比较*P < 0.05;与中危组比较#P < 0.05;与低危组比较△P < 0.05 表 1 HBP、PCT、WBC均值比较(x±s)
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HBP对CAP诊断价值最高,敏感及特异度均高于PCT、WBC(见表 2)。根据测定结果绘制ROC曲线见图 1。
指标 曲线下面积 P 临界值 敏感度/% 特异度/% HBP/(ng/mL) 0.998 < 0.01 12.330 100.0 96.7 PCT/(ng/mL) 0.757 < 0.01 0.370 85.7 56.7 WBC/(×109/L) 0.779 < 0.01 9.790 71.4 78.3 表 2 HBP、PCT、WBC对CAP诊断价值
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Pearson相关分析可见散点呈直线趋势,HBP指标与PSI呈正相关关系(r=0.873,P < 0.05)(见图 2)。
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存活组CAP病人入院检测HBP、PCT平均值与死亡组比较,差异有统计学意义(P < 0.01);WBC平均值与死亡组比较,差异无统计学意义(P>0.05)(见表 3)。
分组 n HBP/(ng/mL) PCT/(ng/mL) WBC/(×109/L) 存活组 38 125.43±23.76 5.83±2.85 15.75±4.89 死亡组 9 197.65±46.75 10.87±4.28 17.67±5.35 t — 4.50 4.31 1.04 P — < 0.01 < 0.01 >0.05 表 3 高危组CAP病人死亡组与存活组各指标对比(x±s)
肝素结合蛋白对社区获得性肺炎诊断价值及预后评估
Study on the diagnostic and prognostic evaluation value of heparin-binding protein in community-acquired pneumonia
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摘要:
目的探讨肝素结合蛋白(HBP)对社区获得性肺炎(CAP)的诊断价值和预后评估作用。 方法选取115例CAP病人,按照肺炎严重指数(PSI)评分分组,低危组 < 90分25例,中危组90~130分43例,高危组>130分47例,另选取同期体检健康者42例作为对照组,入院后分别进行HBP检测,并与降钙素原(PCT)、白细胞(WBC)计数指标对比,统计分析各指标组间差异。ROC曲线分析各指标对CAP诊断效能。分析HBP指标与PSI评分相关性,统计高危组CAP病人死亡及存活例数,对比HBP指标关系。 结果高危组HBP水平[(187.05±48.96)ng/mL]高于中危组[(16.80±5.34)ng/mL]、低危组[(13.49±4.87)ng/mL]、对照组(5.34±1.50)ng/mL(P < 0.05),中低危组HBP差异无统计学意义(P>0.05)。HBP诊断CAP灵敏度及特异度分别为100.0%、96.7%。HBP指标与PSI呈正相关关系(P < 0.05),高危组CAP病人死亡组HBP(197.65±46.75)ng/mL明显高于存活组HBP(125.43±23.76)ng/mL(P < 0.01)。 结论HBP对于CAP诊断(尤其是高危组)有辅助价值,故可用于评估病情严重程度,亦作为CAP预后评估参考指标之一。 Abstract:ObjectiveTo evaluate the diagnostic and prognosis value of heparin-binding protein(HBP) in community-acquired pneumonia(CAP) patients. MethodsAccording to the pneumonia severity index(PSI) score, 115 CAP patients were divided into the low-risk group(25 cases with < 90 points), middle-risk group(43 cases with 90-130 points) and high-risk group(47 cases with>130 points).Forty-two healthy people were set as the control group.The heparin-binding protein(HBP) in all cases were tested after admission, which were compared and analyzed with the procalcitonin(PCT) and white blood cell(WBC).The ROC curve was used to analyze the diagnostic efficacy of each index to CAP.The correlation between HBP index and PSI score was analyzed, the number of death and survival cases in the high risk group were counted, and which was compared with HBP index. ResultsThe HBP level in high-risk group[(187.05±48.96) ng/mL] were higher than that in middle-risk group[(16.80±5.34) ng/mL], low-risk group[(13.49±4.87)ng/mL] and control group[(5.34±1.50) ng/mL], the differences of HBP level between high-risk group and other groups were statistically significant(P < 0.05), and the difference of HBP level between middle and low risk groups was not statistically significant(P>0.05).The diagnostic sensitivity and specificity of heparin binding protein were 100.0% and 96.7%, respectively.The HBP indicators were positively correlated with PSI(P < 0.05).In the high-risk group, the HBP levels in death group[(197.65±46.75) ng/mL] was significantly higher than that in survival group[(125.43±23.76) ng/mL](P < 0.01). ConclusionsThe HBP is of auxiliary value in the diagnosis of CAP(especially in high-risk group), so it can be used to evaluate the severity of the disease.It is also one of the reference index for the prognosis evaluation of CAP. -
Key words:
- community-acquired pneumonia /
- heparin-binding protein /
- procalcitonin /
- white blood cell
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表 1 HBP、PCT、WBC均值比较(x±s)
分组 n HBP/(ng/mL) PCT/(ng/mL) WBC/(×109/L) 高危组 47 187.05±48.96 8.73±2.25 16.82±4.42 中危组 43 16.80±5.34* 1.40±0.62* 16.20±5.25 低危组 25 13.49±4.87* 1.01±0.43* 12.34±3.45 对照组 42 5.34±1.50*#△ 0.30±0.08*#△ 7.20±1.35*#△ H — 24.72 14.73 12.70 P — < 0.01 < 0.05 < 0.05 H检验:与高危组比较*P < 0.05;与中危组比较#P < 0.05;与低危组比较△P < 0.05 表 2 HBP、PCT、WBC对CAP诊断价值
指标 曲线下面积 P 临界值 敏感度/% 特异度/% HBP/(ng/mL) 0.998 < 0.01 12.330 100.0 96.7 PCT/(ng/mL) 0.757 < 0.01 0.370 85.7 56.7 WBC/(×109/L) 0.779 < 0.01 9.790 71.4 78.3 表 3 高危组CAP病人死亡组与存活组各指标对比(x±s)
分组 n HBP/(ng/mL) PCT/(ng/mL) WBC/(×109/L) 存活组 38 125.43±23.76 5.83±2.85 15.75±4.89 死亡组 9 197.65±46.75 10.87±4.28 17.67±5.35 t — 4.50 4.31 1.04 P — < 0.01 < 0.01 >0.05 -
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