多种生物标志物对重症社区获得性肺炎诊断及短期预后预测的价值评价
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摘要
目的评价初始癌胚抗原(CEA)、铁蛋白、D-二聚体(D-dimer)、纤维蛋白原降解物(FDP)及C反应蛋白(CRP)对重症社区获得性肺炎(SCAP)诊断及预后的价值。方法采用前瞻性观察研究方法,纳入177例研究对象,分为SCAP组、普通肺炎(CAP)组及健康人群(HP)组,比较各组生物标志物初始值差异;评价单个指标及联合指标诊断SCAP的效能及对预后的预测价值;SCAP患者根据CEA水平分为CEA升高组及正常组,分析两组间预后及生物标志物水平差异。结果两组肺炎患者较HP组的上述生物标志物均明显升高(P<0.01),SCAP组较CAP组亦明显升高(P<0.001);CEA、铁蛋白、D-dimer、CRP、WBC及联合五项指标预测诊断SCAP受试者工作曲线下面积分别为0.800、0.834、0.769、0.898、0.756和0.956,其中联合五项指标的敏感度为91.8%,特异性为90.5%。SCAP患者中,CEA对病死率预测有意义(P<0.01),CEA升高组较正常组在28天病死率、插管率、住RICU时间、FDP、D-dimer有明显差异(P<0.05)。结论高水平CEA、铁蛋白、D-dimer、CRP及WBC对SCAP诊断有一定价值,联合指标诊断价值更高;SCAP患者伴CEA升高提示病情严重及预后不佳。
Objective To evaluate the value of carcinoembryonic antigen(CEA), ferritin, D-dimer, fibrinogen degradation product(FDP), white blood cell(WBC) and C-reactive protein(CRP) in diagnosis and prognosis of severe community-acquired pneumonia(SCAP). Methods This was a prospective observational study. One hundred and seventy-seven candidates were divided into 3 groups: SCAP group including 61 SCAP patients, CAP group including 56 patients with normal community-acquired pneumonia group and HP group including 60 healthy people. Initial level of above biomarkers was compared and analyzed in the three groups. Then the efficiency of diagnosing and predicting the outcome of SCAP by single and combined index were evaluated by receiver operating characteristic(ROC) curve.Meanwhile the patients in SCAP group were divided into two groups according to the CEA level named CEA increasing group and normal group, between which the differences in prognosis and biomarker level were compared. Results The initial level of all biomarkers increased in two pneumonia groups and exceeded the HP group(P< 0.01) while between SCAP and CAP groups, all indexes in SCAP group were higher than the CAP group(P< 0.001). The areas under the ROC of CEA, ferritin, D-dimer, CRP, WBC and united respectively were 0.800, 0.834, 0.769, 0.898, 0.756 and 0.956. The sensitivity of united index was 91.8% while specificity was 90.5%. Among SCAP group, only CEA level made sense to predict the prognosis(P< 0.01). There were significant differences in intubation rate, mortality, length of RICU stay and FDP, D-dimer between CEA increasing group and normal group(P< 0.05). Conclusions High level CEA, ferritin,D-dimer, CRP and WBC have significant value in diagnosis of SCAP. And the combined index has higher diagnostic value than single one. SCAP with increased CEA level indicates more serious condition and poor prognosis.
Objective To evaluate the value of carcinoembryonic antigen(CEA), ferritin, D-dimer, fibrinogen degradation product(FDP), white blood cell(WBC) and C-reactive protein(CRP) in diagnosis and prognosis of severe community-acquired pneumonia(SCAP). Methods This was a prospective observational study. One hundred and seventy-seven candidates were divided into 3 groups: SCAP group including 61 SCAP patients, CAP group including 56 patients with normal community-acquired pneumonia group and HP group including 60 healthy people. Initial level of above biomarkers was compared and analyzed in the three groups. Then the efficiency of diagnosing and predicting the outcome of SCAP by single and combined index were evaluated by receiver operating characteristic(ROC) curve.Meanwhile the patients in SCAP group were divided into two groups according to the CEA level named CEA increasing group and normal group, between which the differences in prognosis and biomarker level were compared. Results The initial level of all biomarkers increased in two pneumonia groups and exceeded the HP group(P< 0.01) while between SCAP and CAP groups, all indexes in SCAP group were higher than the CAP group(P< 0.001). The areas under the ROC of CEA, ferritin, D-dimer, CRP, WBC and united respectively were 0.800, 0.834, 0.769, 0.898, 0.756 and 0.956. The sensitivity of united index was 91.8% while specificity was 90.5%. Among SCAP group, only CEA level made sense to predict the prognosis(P< 0.01). There were significant differences in intubation rate, mortality, length of RICU stay and FDP, D-dimer between CEA increasing group and normal group(P< 0.05). Conclusions High level CEA, ferritin,D-dimer, CRP and WBC have significant value in diagnosis of SCAP. And the combined index has higher diagnostic value than single one. SCAP with increased CEA level indicates more serious condition and poor prognosis.
引文
1 Chalmers JD. Identifying severe community-acquired pneumonia:moving beyond mortality. Thorax, 2015, 70(6):515-516.
2 Torres A, Loeches M, Menendez R. Research in communityacquired pneumonia:the next steps. Intensive Care Med, 2017,43(9):1395-1397.
3瞿介明,曹彬,中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版).中华结核和呼吸杂志,2016,39(4):253-279.
4 Frenzen FS, Kutschan U, Meiswinkel N, et al. Admission lactate predicts poor prognosis independently of the CRB/CURB-65scores in community-acquired pneumonia. Clin Microbiol Infect,2018, 24(3):301-306.
5孔庆华,白久武,王晓如,等.三种评分系统在老年社区获得性肺炎危险度分层及病情评估中的应用.中国呼吸与危重监护杂志,2018, 17(2):138-143.
6刘波,单南冰.ICU危重患者APACHEⅡ评分变化率和临床预后的关系.内科急危重症杂志,2017, 23(2):142-144.
7 Brabrand M, Henriksen DP. CURB-65 score is equal to NEWS for identifying mortality risk of pneumonia patients:an observationalstudy. Lung, 2018,196(3):359-361.
8 Bramswig KH, Poettler M, Unseld M, et al. Soluble carcinoembryonic antigen activates endothelial cells and tumor angiogenesis. Cancer Res, 2013, 73(22):6584-6596.
9 Jiang ZF, Wang M, Xu JL. Thymidine kinase 1 combined with CEA,CYFRA21-1 and NSE improved its diagnostic value for lung cancer. Life Sci, 2018, 194(1):1-6.
10 Bacac M, Klein C, Umana P. CEA TCB:a novel head-to-tail 2:1 T cell bispecific antibody for treatment of CEA-positive solid tumors.Oncoimmunology, 2016, 5(8):e 1203498.
11 Noguchi T, Yamamoto K, Moriyama G, et al. Evaluation of serum levels of carcinoembryonic antigen in allergic bronchopulmonary aspergillosis. J Nippon Med Sch, 2013, 80(6):404-409.
12 Arosio P, Elia L, Poli M. Ferritin, cellular iron storage and regulation. IUBMB Life, 2017, 69(6):414-422.
13徐麒麟,康波,姜冬梅.铁蛋自介导细胞凋亡的作用机制.中国生物化学与分子生物学报,2016, 32(11):1213-1218.
14中国医药教育协会感染疾病专业委员会.感染相关生物标志物临床意义解读专家共识.中华结核和呼吸杂志,2017, 40(4):243-257.
15 Wu JJ, Jin Y, Li HL, et al. Evaluation and significance of C-reactive protein in the clinical diagnosis of severe pneumonia. Exp Ther Med, 2015, 10(1):175-180.
16 Chou SC, Ko HW, Lin YC. CRP/IL-6/IL-10 single-nucleotide polymorphisms correlate with the susceptibility and severity of community-acquired pneumonia. Genet Test Mol Biomarkers,2016, 20(12):732-740.
17 Wu M, Jiang ZF, Xie JL, et al. Role of the fibrinogen degradation products and D-dimer in the differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia. Clin Lab, 2018,64(1):135-140.
18徐悦利,张阳,姜锋.不同严重程度社区获得性肺炎患者凝血及纤溶相关指标的比较.中华医学杂志,2015, 95(24):1925-1929.
2 Torres A, Loeches M, Menendez R. Research in communityacquired pneumonia:the next steps. Intensive Care Med, 2017,43(9):1395-1397.
3瞿介明,曹彬,中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版).中华结核和呼吸杂志,2016,39(4):253-279.
4 Frenzen FS, Kutschan U, Meiswinkel N, et al. Admission lactate predicts poor prognosis independently of the CRB/CURB-65scores in community-acquired pneumonia. Clin Microbiol Infect,2018, 24(3):301-306.
5孔庆华,白久武,王晓如,等.三种评分系统在老年社区获得性肺炎危险度分层及病情评估中的应用.中国呼吸与危重监护杂志,2018, 17(2):138-143.
6刘波,单南冰.ICU危重患者APACHEⅡ评分变化率和临床预后的关系.内科急危重症杂志,2017, 23(2):142-144.
7 Brabrand M, Henriksen DP. CURB-65 score is equal to NEWS for identifying mortality risk of pneumonia patients:an observationalstudy. Lung, 2018,196(3):359-361.
8 Bramswig KH, Poettler M, Unseld M, et al. Soluble carcinoembryonic antigen activates endothelial cells and tumor angiogenesis. Cancer Res, 2013, 73(22):6584-6596.
9 Jiang ZF, Wang M, Xu JL. Thymidine kinase 1 combined with CEA,CYFRA21-1 and NSE improved its diagnostic value for lung cancer. Life Sci, 2018, 194(1):1-6.
10 Bacac M, Klein C, Umana P. CEA TCB:a novel head-to-tail 2:1 T cell bispecific antibody for treatment of CEA-positive solid tumors.Oncoimmunology, 2016, 5(8):e 1203498.
11 Noguchi T, Yamamoto K, Moriyama G, et al. Evaluation of serum levels of carcinoembryonic antigen in allergic bronchopulmonary aspergillosis. J Nippon Med Sch, 2013, 80(6):404-409.
12 Arosio P, Elia L, Poli M. Ferritin, cellular iron storage and regulation. IUBMB Life, 2017, 69(6):414-422.
13徐麒麟,康波,姜冬梅.铁蛋自介导细胞凋亡的作用机制.中国生物化学与分子生物学报,2016, 32(11):1213-1218.
14中国医药教育协会感染疾病专业委员会.感染相关生物标志物临床意义解读专家共识.中华结核和呼吸杂志,2017, 40(4):243-257.
15 Wu JJ, Jin Y, Li HL, et al. Evaluation and significance of C-reactive protein in the clinical diagnosis of severe pneumonia. Exp Ther Med, 2015, 10(1):175-180.
16 Chou SC, Ko HW, Lin YC. CRP/IL-6/IL-10 single-nucleotide polymorphisms correlate with the susceptibility and severity of community-acquired pneumonia. Genet Test Mol Biomarkers,2016, 20(12):732-740.
17 Wu M, Jiang ZF, Xie JL, et al. Role of the fibrinogen degradation products and D-dimer in the differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia. Clin Lab, 2018,64(1):135-140.
18徐悦利,张阳,姜锋.不同严重程度社区获得性肺炎患者凝血及纤溶相关指标的比较.中华医学杂志,2015, 95(24):1925-1929.