肺表面活性蛋白A在渗出性胸腔积液中的临床应用  

Clinical value of surfactant protein-A in exudate pleural effusion

作　　者：关晶 李建民[2] 汪洋[3] 刘志光[2] 龙小平 潘婵苑 GUAN Jing1, LI Jianmin2, WANG Yang3, LIU Zhiguang2, LONG Xiaoping4, PAN Chanyuan2(1. Department of Emergency,The First Hospital of Changsha, Changsha 410005; 2. Departmen of Respiratory Medicine, Hunan Provincial People＇s Hospital, Changsha 410005; 3. Department of Pathology, Second Xiangya Hospital, Central South University, Changsha 410011; 4. Department of Respiratory Medicine, The First Hospital Affiliated to University of South China, Hengyang Hunan 421001, Chin)

机构地区：[1]长沙市第一医院急诊科,长沙410005 [2]湖南省人民医院呼吸内科,长沙410005 [3]中南大学湘雅二医院病理科,长沙410011 [4]南华大学附属第一医院呼吸内科,湖南衡阳421001

出　　处：《中南大学学报（医学版）》2018年第3期268-273,共6页Journal of Central South University ：Medical Science

基　　金：湖南省卫生和计划生育委员会科研项目(B2016013);长沙市科技局项目(k1508037-31)~~

摘　　要：目的:评估肺表面活性蛋白A(surfactant protein-A,SP-A)在诊断渗出性胸腔积液(exudate pleural effusions,EPE)中的临床应用价值。方法:采用前瞻性研究,选取215例胸腔积液患者,分漏出性胸腔积液(transudate pleural effusions,TPE)和EPE两组,TPE组作为对照组。运用ELISA实验测定并比较胸腔积液中SP-A(pleural effusion SP-A,SP-Apl)和血清中SP-A(serum SP-A,SP-Ase)浓度。运用受试者工作特征(receiver operator characteristic,ROC)曲线及多变量Cox回归研究SP-A在诊断胸腔积液中的临床价值。结果:EPE组SP-Apl浓度明显高于TPE组[(189.8±43.4)ng/m L vs(22.3±5.1)ng/m L,P<0.01];EPE组SP-Ase浓度明显高于TPE组[(78.9±11.3)ng/m L vs(25.8±12.4)ng/m L,P<0.05];EPE组SP-Apl浓度明显高于SP-Ase浓度(P<0.01)。EPE组中肺腺癌患者SP-Apl浓度和SP-Ase浓度最高,且SP-Apl浓度明显高于SP-Ase浓度(P<0.01)。当SP-Apl浓度≥484.5 ng/m L时,诊断肺腺癌的敏感性为85.4%,特异性为95.2%,曲线下面积(area under the curve,AUC)为0.943(95%CI:0.852~0.934,P<0.01);当SP-Ase≥84.2 ng/m L时,诊断肺腺癌的敏感性为76.4%,特异性为94.3%,AUC为0.910(95%CI:0.921~0.953,P<0.01)。结论:SP-Apl浓度≥484.5 ng/m L和/或SP-Ase浓度≥84.2 ng/m L有助于诊断肺腺癌性胸腔积液。Objective： To evaluate the clinical value of surfactant protein-A （SP-A） in exudate pleural effusion （EPE）.Methods： This clinical study was prospective, observational and cross-sectional. Two hundred and fifteen patients with pleural effusion were divided into the transudate pleural effusions （TPE） group and the EPE group. TPE patients served as the control group. The concentrations of pleural effusions SP-A （SP-A^pl） and serum SP-A （SP-A^se） were measured by ELISA, and receiver operator characteristic （ROC） curve and multivarate Cox analysis of SP-A was analysed for its clinical value. Results： SP-A^pl concentrations in the EPE group were significantly higher than that in the TPE group [（189.8±43.4） ng/mL vs （22.3±5.1） ng/mL, P〈0.01]; SP-A^se concentrations in the EPE group were higher than that in the TPE group [（78.9±11.3） ng/mL vs （25.8±12.4） ng/mL, P〈0.05];SP-A^pl concentrations were significantly higher than the concentrations of SP-A^se in the EPE group （P〈0.01）. In EPE group, SP-A^pl and SP-A^se concentration in the patients with primary lung adenocarcinomas were the highest. The cut off value of SP-A^pl concentrations was more than 484.5 ng/mL, yielding a 85.4% sensitivity and 95.2% specificity for diagnosing primary lung adenocarcinomas, with an area under the curve （AUC） of 0.943 （95% CI 0.852 to 0.934, P〈0.01）;when SP-Ase concentration was more than 84.2 ng/mL, it yielded a 76.4% sensitivity and 94.3% specificity for diagnosing primary lung adenocarcinomas, with an AUC of 0.910 （95% CI 0.921 to 0.953, P〈0.01）.Conclusion： While SP-A^pl concentration is more than 484.5 ng/mL and/or SP-A^se concentration is more than 84.2 ng/mL, it may be helpful for the diagnosis of primary lung adenocarcinomas with the usage of pleural effusion.

关 键 词：肺表面活性蛋白A 胸腔积液 敏感性 特异性 受试者工作特征曲线 

分 类 号：R561.3[医药卫生—呼吸系统]