血清中性粒细胞明胶酶相关脂质运载蛋白与炎症反应的关系及对重症社区获得性肺炎的诊断价值  

Correlation of serum neutrophil gelatinase-associated lipocalin with inflammatory response and its diagnostic value for severe community-acquired pneumonia

作　　者：康国平[1] 朱宇[2] 杨欢 张骥[1] 程海容 唐梓文 刘伟贤 KANG Guoping;ZHU Yu;YANG Huan;ZHANG Ji;CHENG Hairong;TANG Ziwen;LIU Weixian(Emergency Department,Bazhong Central Hospital,Bazhong,Sichuan 636000,P.R.China;Department of Respiratory Medicine,Bazhong Central Hospital,Bazhong,Sichuan 636000,P.R.China)

机构地区：[1]巴中市中心医院急诊科,四川巴中636000 [2]巴中市中心医院呼吸内科,四川巴中636000

出　　处：《华西医学》2020年第1期17-21,共5页West China Medical Journal

基　　金：四川省医学科研青年创新课题(Q18058)

摘　　要：目的探讨社区获得性肺炎(community-acquired pneumonia,CAP)患者血清中性粒细胞明胶酶相关脂质运载蛋白(serum neutrophil gelatinase-associated lipocalin,sNGAL)与炎症反应的相关性及其对重症CAP(severe CAP,SCAP)的诊断价值。方法选择2018年1月-2019年6月巴中市中心医院急诊住院的成年(年龄18~75岁)CAP患者85例,比较SCAP组(34例)和非SCAP组(51例)的年龄、住院天数、血肌酐、尿素氮、白细胞计数、C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、降钙素原(procalcitonin,PCT)及CURB-65评分等临床参数的差异。分析sNGAL与血肌酐、尿素氮、白细胞计数、CRP、IL-6、PCT以及CURB-65评分的相关关系。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析sNGAL诊断SCAP的准确性。结果与非SCAP组比较,SCAP组年龄更高,住院天数延长,sNGAL、CRP、IL-6、CURB-65评分明显增高,差异均有统计学意义(P<0.05)。Spearman相关分析示sNGAL与CRP、IL-6、PCT及CURB-65呈正相关,rs分别为0.472、0.504、0.388和0.405,均有统计学意义(P<0.01)。sNGAL诊断SCAP的ROC曲线下面积为0.816,以171.0 ng/mL为截断值,诊断SCAP的灵敏度和特异度分别为76.5%和74.5%。结论sNGAL水平与CAP严重程度呈正相关,并且可以作为诊断SCAP的辅助指标。Objective To explore the correlation of serum neutrophil gelatinase-associated lipocalin(sNGAL) with inflammatory response in patients with community-acquired pneumonia(CAP)and assess the diagnostic value of sNGAL for severe CAP(SCAP).Methods From January 2018 to June 2019,a total of 85 patients with CAP were enrolled in this study.Age,length of hospital stay,the levels of serum creatinine,blood urea nitrogen,white blood cell count,C-reactive protein(CRP),interleukin-6(IL-6),and procalcitonin,and CURB-65 score were compared between patients with SCAP(n=34)and patients without SCAP(n=51).The correlations of sNGAL with serum creatinine,blood urea nitrogen,white blood cell count,CRP,IL-6,procalcitonin,and CURB-65 score were assessed with Spearman’s correlation analysis.The area under the receiver operating characteristic(ROC)curve for sNGAL diagnosing SCAP was examined.Results Compared with patients without SCAP,SCAP patients demonstrated older age,longer hospital stay,higher serum CRP and IL-6 concentritions,and higher CURB-65 score(P<0.05).The Spearman’s correlation test showed that sNGAL was positively correlated with serum CRP,IL-6,PCT and CURB-65 score(rs=0.472,0.504,0.388,and 0.405,respectively;P<0.01).According to ROC analysis,the area under curve of sNGAL for diagnosing SCAP were0.816,with a sensitivity of 76.56%and a specificity of 74.4%when the cut-off value was 171.0 ng/mL.Conclusions sNGAL concentration is positively correlated with the serverity of CAP.It can be regarded as a reliable indicator for diagnosis of SCAP in patients with CAP.

关 键 词：社区获得性肺炎 重症肺炎 中性粒细胞明胶酶相关脂质运载蛋白 C反应蛋白 白细胞介素-6 降钙素原 炎症反应 

分 类 号：R563.1[医药卫生—呼吸系统]