成人社区获得性肺炎患者血清颗粒蛋白前体和淀粉样蛋白A检测的临床意义  

The clinical significance of serum progranulin and amyloid A levels in patients with community acquired pneumonia

作　　者：郭水根 徐春燕 朱先极 杨叶梦 包红 GUO Shuigen;XU Chunyan;ZHU Xianji;YANG Yemeng;BAO Hong(Department of Respiratory Medicine,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399,China)

机构地区：[1]上海市浦东医院,复旦大学附属浦东医院呼吸内科,上海201399

出　　处：《中国感染与化疗杂志》2020年第3期306-311,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨成人社区获得性肺炎(CAP)患者血清颗粒蛋白前体(PGRN)和血清淀粉样蛋白A(SAA)水平,阐明其在CAP诊治中的价值。方法选择上海市浦东医院2018年1月-2019年4月CAP患者120例作为CAP组,同期健康体检成人120名作为对照组。测定血清PGRN、SAA、C反应蛋白(CRP)、降钙素原(PCT)水平。结果 CAP组血清PGRN、SAA、CRP、PCT水平均高于对照组(P<0.05)。CAP重症组血清PGRN、SAA、CRP、PCT水平均高于非重症组(P<0.05)。CAP死亡组血清PGRN、SAA、CRP、PCT水平均高于好转组(P<0.05)。CAP患者血清PGRN、SAA水平与CRP、PCT水平变化均呈正相关(P<0.05)。血清PGRN、SAA、CRP、PCT水平及其联合诊断CAP的受试者工作特征(ROC)曲线的曲线下面积分别为0.832、0.827、0.721、0.750、0.902;灵敏度分别为73.2%、69.6%、75.1%、63.6%、84.7%;特异度分别为76.5%、74.2%、68.4%、77.5%、94.4%。血清PGRN、SAA水平诊断重症CAP的ROC曲线的曲线下面积分别为0.735、0.718;诊断死亡CAP的ROC曲线的曲线下面积分别为0.776、0.785。结论成人CAP患者血清PGRN、SAA水平升高,可反映机体炎症程度及病情严重程度和预后,两者联合CRP和PCT可提高CAP的诊断价值。Objective To investigate serum progranulin (PGRN) and serum amyloid A (SAA) levels in adults patients with community acquired pneumonia (CAP) and their utility in the diagnosis and treatment of CAP.Methods This was designed as a case-control study including 120 CAP patients in CAP group,and 120 concurrent healthy adults in control group from January 2018 to April 2019.The serum levels of PGRN,SAA,C-reactive protein (CRP) and procalcitonin (PCT) were measured.Results The serum levels of PGRN,SAA,CRP and PCT were significantly higher in CAP group than in control group (P<0.05).The serum levels of PGRN,SAA,CRP and PCT were significantly higher in severe patients than in non-severe patients (P<0.05).The serum levels of PGRN,SAA,CRP and PCT were significantly higher in the CAP patients with deadly outcome than in the CAP patients with improved outcome (P<0.05).The levels of serum PGRN and SAA were positively correlated with CRP and PCT levels in CAP patients (P<0.05).The area under the receiver operating characteristic (ROC) curve of serum PGRN,SAA,CRP,PCT for diagnosis of CAP was 0.832,0.827,0.721,0.750,0.902,respectively.The sensitivity was 73.2%,69.6%,75.1%,63.6%,and 84.7%,respectively.The specificity was 76.5%,74.2%,68.4%,77.5%,and 94.4%,respectively.The area under the ROC curve of serum PGRN and SAA for diagnosis of severe CAP was 0.735 and 0.718,respectively.The area under the ROC curve of serum PGRN and SAA in prediction of deadly CAP outcome was 0.776 and 0.785,respectively.Conclusions The levels of serum PGRN and SAA are elevated in adult CAP patients.Serum PGRN and SAA can reflect the degree of inflammation,severity and prognosis of the disease.Serum PGRN and SAA combined with CRP and PCT can increase the diagnostic utility for CAP.

关 键 词：社区获得性肺炎 血清颗粒蛋白前体 血清淀粉样蛋白A C反应蛋白 降钙素原 

分 类 号：R563.1[医药卫生—呼吸系统]