尿毒症维持性血液透析合并肺部感染患者血清NGAL和MMP-9的表达水平  

Expression levels of serum NGAL and MMP-9 in patients with uremia maintenance hemodialysis complicated with pulmonary infection

作　　者：王丽丽[1] 王莉华[1] 高永宁[1] 侯晶晶[1] 申磊[1] WANG Li-li;WANG Li-hua;GAO Yong-ning;HOU Jing-jing;SHEN Lei(Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北医科大学第二医院血液透析科,河北石家庄050000

出　　处：《中华医院感染学杂志》2020年第12期1835-1839,共5页Chinese Journal of Nosocomiology

基　　金：河北省科技成果推广基金资助项目(20170092)。

摘　　要：目的探究尿毒症维持性血液透析合并肺部感染患者血清中性粒细胞载脂蛋白(Neutrophil gelatinase-associated lipocalin,NGAL)、基质金属蛋白酶-9(Matrix metalloproteinase-9,MMP-9)的表达水平并分析其检测意义。方法选取2017年2月-2019年2月于河北医科大学第二医院就诊的尿毒症维持性血液透析患者180例为研究对象,按照是否合并肺部感染分为感染组56例和对照组124例。统计感染组患者检出病原菌情况。测定两组患者血清NGAL和MMP-9水平,并采用受试者工作特征曲线对其诊断价值进行评价。结果尿毒症维持血液透析合并肺部感染患者中,共培养分离病原菌76株,其中革兰阴性菌47株占61.84%,革兰阳性菌24株占31.58%,真菌5株占6.58%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、屎肠球菌和粪肠球菌为主。感染组患者血清NGAL和MMP-9分别为(37.56±7.93)ng/ml和(1 270.64±378.07)ng/ml高于对照组(P<0.001);血清NGAL、MMP-9两者联合检测筛查的敏感度(93.80%)和特异性(81.00%)、ROC曲线下面积(AUC)(0.985)、阳性预测值(90.57%)、阴性预测值(87.61%)均高于单一指标检测的值。结论尿毒症维持血液透析合并肺部感染患者血清NGAL、MMP-9水平升高,联合检测其水平对患者进行诊断,其特异性和灵敏度较高,具有一定的临床价值。OBJECTIVE To investigate the expression level of serum neutrophil apolipoprotein(NGAL) and matrix metalloproteinase-9(MMP-9) in uremic maintenance hemodialysis patients with pulmonary infection and analyze their detection significance. METHODS A total of 180 patients with uremia maintenance hemodialysis who were treated at the Second Hospital of Hebei Medical University from Feb. 2017 to Feb. 2019 were selected as the research subjects. They were divided into 56 cases of infection group and 124 cases of control group according to whether they had pulmonary infection. The distribution of pathogens was detected in patients in the infection group. Serum NGAL and MMP-9 levels of patients in the two groups were measured, and their diagnostic values were evaluated using receiver operating characteristic curves. RESULTS Among the patients with uremic maintenance hemodialysis and pulmonary infection, 76 strains of pathogenic bacteria were isolated, of which 47 strains of Gram-negative bacteria accounted for 61.84%, 24 strains of Gram-positive bacteria accounted for 31.58%, and 5 strains of fungi accounted for 6.58%. The main strains were Escherichia coli, Klebsiella pneumoniae, P. aeruginosa, Enterococcus faecium and Enterococcus faecalis. The serum NGAL and MMP-9 in the infection group were(37.56±7.93)ng/ml and(1270.64±378.07)ng/ml, respectively, significantly higher than those in the control group(P<0.001). The sensitivity(93.80%) and specificity(81.00%), area under ROC curve(AUC)(0.985), positive predictive value(90.57%) and negative predictive value(87.61%) were all higher than those measured by a single index. CONCLUSION The serum NGAL and MMP-9 levels in patients with uremic maintenance hemodialysis and pulmonary infection are significantly increased. The combined detection of NGAL and MMP-9 levels is of high specificity and sensitivity, which is worthy of clinical reference.

关 键 词：尿毒症 肺部感染 中性粒细胞载脂蛋白 基质金属蛋白酶-9 

分 类 号：R563.1[医药卫生—呼吸系统]