高敏肌钙蛋白Ⅰ、同型半胱氨酸、炎症因子在急性加重期慢性阻塞性肺疾病中的诊断价值
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摘要
目的探讨高敏肌钙蛋白Ⅰ(hs-cTnI)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)检测在慢性阻塞性肺疾病急性加重期(AECOPD)的诊断价值。方法收集AECOPD患者96例,以50例体检健康者为健康对照组,采用电化学发光法测定hs-cTnI水平、循环酶法测定Hcy水平、免疫比浊法测定hs-CRP水平、胶体金印迹法测定PCT水平,相关性分析采用Pearson相关分析,分析各指标与AECOPD之间的相关性、利用受试者工作特征曲线(ROC曲线)分析hs-cTnI、Hcy、hs-CRP、PCT诊断COPE急性加重期的曲线下面积(AUC)。结果 AECOPD组hs-cTnI、hs-CRP和PCT水平均高于健康对照组,差异有统计学意义(P<0.05),AECOPD组Hcy水平低于健康对照组,差异无统计学意义(P>0.05);Pearson相关性分析中,hscTnI、hs-CRP和PCT水平与AECOPD呈正相关(r分别为0.346、0.401、0.509),Hcy水平与AECOPD相关性较差(r=0.078);ROC分析中,hs-cTnI、hs-CRP和PCT的AUC分别为0.825、0.834、0.922,最佳诊断界值分别为0.082、18.25、3.075,灵敏度分别为0.823、0.802、0.781,特异度分别为0.92、0.62、0.94,约登指数分别为0.743、0.422、0.721,kappa值分别为:0.699、0.423、0.664。结论 Hcy检测对AECOPD诊断价值低,hscTnI、hs-CRP和PCT检测在AECOPD具有一定的诊断价值,可作为AECOPD的辅助诊断指标。
Objective To investigate the diagnostic value of hypersensitive troponin Ⅰ(hs-cTnⅠ),homocysteine(Hcy),hypersensitive C-reactive protein(hs-CRP)and calcitonin(PCT)detection in acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Ninety-six patients with AECOPD were enrolled in this study.50 healthy subjects were included in the healthy control group.Hs-cTnI was measured by electrochemiluminescence,Hcy level was measured by circulating enzyme method,hs-CRP level was determined by immunoturbidimetry,and colloidal gold blotting was performed.PCT levels,correlation analysis using Pearson correlation analysis,analysis of the correlation between the indicators and AECOPD,using ROC curve analysis of hs-cTnI,Hcy,hs-CRP,PCT diagnosis COPE acute exacerbation curve area(AUC).Results The levels of hs-cTnI,hs-CRP and PCT in the AECOPD group were higher than those in the healthy control group(P<0.05).The Hcy in the AECOPD group was lower than that in the healthy control group.The difference was not statistically significant(P>0.05).Pearson correlation analysis shows that hs-cTnI,hsCRP and PCT were positively correlated with AECOPD(r=0.346,0.401,0.509),and Hcy had a poor correlation with AECOPD(r=0.078).In the ROC curve analysis,the area under the curve(AUC)for hs-cTnⅠ,hsCRP,and PCT were 0.825,0.834,and 0.922,respectively,The best diagnostic cut-off values were:0.082,18.25,3.075,and the sensitivities were 0.823,0.802,and 0.781,respectively.The specificities were:0.92,0.62,and 0.94.Youden′s index was 0.743,0.422,and 0.721,respectively.The kappa values are:0.699,0.423,0.664.Conclusion The detection value of Hcy in the diagnosis of AECOPD is low.The detection of hs-cTnⅠ,hsCRP and PCT has a certain diagnostic value in AECOPD.It can be used as an auxiliary diagnosis index of AECOPD.
Objective To investigate the diagnostic value of hypersensitive troponin Ⅰ(hs-cTnⅠ),homocysteine(Hcy),hypersensitive C-reactive protein(hs-CRP)and calcitonin(PCT)detection in acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Ninety-six patients with AECOPD were enrolled in this study.50 healthy subjects were included in the healthy control group.Hs-cTnI was measured by electrochemiluminescence,Hcy level was measured by circulating enzyme method,hs-CRP level was determined by immunoturbidimetry,and colloidal gold blotting was performed.PCT levels,correlation analysis using Pearson correlation analysis,analysis of the correlation between the indicators and AECOPD,using ROC curve analysis of hs-cTnI,Hcy,hs-CRP,PCT diagnosis COPE acute exacerbation curve area(AUC).Results The levels of hs-cTnI,hs-CRP and PCT in the AECOPD group were higher than those in the healthy control group(P<0.05).The Hcy in the AECOPD group was lower than that in the healthy control group.The difference was not statistically significant(P>0.05).Pearson correlation analysis shows that hs-cTnI,hsCRP and PCT were positively correlated with AECOPD(r=0.346,0.401,0.509),and Hcy had a poor correlation with AECOPD(r=0.078).In the ROC curve analysis,the area under the curve(AUC)for hs-cTnⅠ,hsCRP,and PCT were 0.825,0.834,and 0.922,respectively,The best diagnostic cut-off values were:0.082,18.25,3.075,and the sensitivities were 0.823,0.802,and 0.781,respectively.The specificities were:0.92,0.62,and 0.94.Youden′s index was 0.743,0.422,and 0.721,respectively.The kappa values are:0.699,0.423,0.664.Conclusion The detection value of Hcy in the diagnosis of AECOPD is low.The detection of hs-cTnⅠ,hsCRP and PCT has a certain diagnostic value in AECOPD.It can be used as an auxiliary diagnosis index of AECOPD.
引文
[1] BHATT S P.Early chronic obstructive pulmonary disease or early detection of mild disease?[J].Am J Respir Crit Care Med,2018,198(3):411-412.
[2] SUN Y,SIN D D.Crisis of COPD in China:the future is now[J].Lancet Respir Med,2018,6(6):404-405.
[3]庞国菊,刘怀平.血清α1-抗胰蛋白酶和C反应蛋白水平与慢性阻塞性肺疾病的相关性研究[J].检验医学,2013,28(10):882-884.
[4]周忠海,付春生.COPD稳定期患者血清SP-D和CRP表达及意义[J].山东医药,2011,51(31):49-50.
[5]陈迎春.PLR,NLP及C反应蛋白水平检测在慢阻肺急性加重诊断中的应用价值[J].当代医学,2017,24(25):100-101.
[6]王伍支,宋英.Hcy、hs-CRP及脂蛋白水平在老年冠心病病人中的诊断价值及应用[J].中西医结合心脑血管病杂志,2017,15(7):836-838.
[7]杨丹,王昌明,马礼兵,等.LPS对COPD大鼠肺动脉平滑肌细胞microRNA-146a的表达及合成分泌IL-6的诱导作用[J].广东医学,2017,55(23):3554-3557.
[8] TURRINI I,SORBI F,GHIZZONI V,et al.Severe fetal distress and placental damage might be associated with high troponin I(cTnI)levels in mothers[J].Am J Case Rep,2018,22(19):194-198.
[9] SHANMUGAM N R,MUTHUKUMAR S,TANAK A S,et al.Multiplexed electrochemical detection of three cardiac biomarkers cTnI,cTnT and BNP using nanostructured ZnO-sensing platform[J].Future Cardiol,2018,14(2):131-141.
[10]罗广彬.血浆BNP水平和血清hs-CRP水平检测在不同程度COPD中临床应用[J].国际检验医学杂志,2017,38(6):838-840.
[11]赵燕霞,黄相增.NT-Pro BNP、CRP及D-Dimer在COPD急性加重期合并肺动脉高压中的相关性研究[J].国际呼吸杂志,2014,34(5):341-346.
[12]刘剑臻,杜秀芳.COPD急性加重期患者血清CRP和PCT含量与全身炎症反应程度的相关性分析[J].海南医学院学报,2017,23(5):620-622.
[13]孙丽蓉,王海龙,高扬,等.IL-1、IL-6基因多态性与慢性阻塞性肺疾病肺动脉高压相关性研究[J].医学研究杂志,2013,42(11):80-84.
[14]施玉琴,杨荣时,曾玉兰.COPD患者血清肺表面活性物质蛋白D与炎性标记物的相关性[J].临床肺科杂志,2014,19(5):788-790.
[15]宋亚茹,李荣凯,翟成凯.慢性阻塞性肺疾病患者外周血IL-35表达水平的检测及意义[J].国际呼吸杂志,2015,35(20):1545-1549.
[2] SUN Y,SIN D D.Crisis of COPD in China:the future is now[J].Lancet Respir Med,2018,6(6):404-405.
[3]庞国菊,刘怀平.血清α1-抗胰蛋白酶和C反应蛋白水平与慢性阻塞性肺疾病的相关性研究[J].检验医学,2013,28(10):882-884.
[4]周忠海,付春生.COPD稳定期患者血清SP-D和CRP表达及意义[J].山东医药,2011,51(31):49-50.
[5]陈迎春.PLR,NLP及C反应蛋白水平检测在慢阻肺急性加重诊断中的应用价值[J].当代医学,2017,24(25):100-101.
[6]王伍支,宋英.Hcy、hs-CRP及脂蛋白水平在老年冠心病病人中的诊断价值及应用[J].中西医结合心脑血管病杂志,2017,15(7):836-838.
[7]杨丹,王昌明,马礼兵,等.LPS对COPD大鼠肺动脉平滑肌细胞microRNA-146a的表达及合成分泌IL-6的诱导作用[J].广东医学,2017,55(23):3554-3557.
[8] TURRINI I,SORBI F,GHIZZONI V,et al.Severe fetal distress and placental damage might be associated with high troponin I(cTnI)levels in mothers[J].Am J Case Rep,2018,22(19):194-198.
[9] SHANMUGAM N R,MUTHUKUMAR S,TANAK A S,et al.Multiplexed electrochemical detection of three cardiac biomarkers cTnI,cTnT and BNP using nanostructured ZnO-sensing platform[J].Future Cardiol,2018,14(2):131-141.
[10]罗广彬.血浆BNP水平和血清hs-CRP水平检测在不同程度COPD中临床应用[J].国际检验医学杂志,2017,38(6):838-840.
[11]赵燕霞,黄相增.NT-Pro BNP、CRP及D-Dimer在COPD急性加重期合并肺动脉高压中的相关性研究[J].国际呼吸杂志,2014,34(5):341-346.
[12]刘剑臻,杜秀芳.COPD急性加重期患者血清CRP和PCT含量与全身炎症反应程度的相关性分析[J].海南医学院学报,2017,23(5):620-622.
[13]孙丽蓉,王海龙,高扬,等.IL-1、IL-6基因多态性与慢性阻塞性肺疾病肺动脉高压相关性研究[J].医学研究杂志,2013,42(11):80-84.
[14]施玉琴,杨荣时,曾玉兰.COPD患者血清肺表面活性物质蛋白D与炎性标记物的相关性[J].临床肺科杂志,2014,19(5):788-790.
[15]宋亚茹,李荣凯,翟成凯.慢性阻塞性肺疾病患者外周血IL-35表达水平的检测及意义[J].国际呼吸杂志,2015,35(20):1545-1549.