酸性哺乳动物几丁质酶早期诊断职业性尘肺病价值  

The value of acidic mammalian chitinase in early diagnosis of occupational pneumoconiosis

作　　者：朱莹 姚婧昕 段雨霞 徐洪 袁聚祥 ZHU Ying;YAO Jing-xin;DUAN Yu-xia;XU Hong;YUAN Ju-xiang(School of Public Health,The Hebei Key Laboratory for Organ Fibrosis Research,North China University of Science and Technology,Tangshan,Hebei 063210,China)

机构地区：[1]华北理工大学公共卫生学院,河北省器官纤维化重点实验室,河北唐山063210

出　　处：《中国职业医学》2021年第1期6-11,18,共7页China Occupational Medicine

基　　金：国家科技部重点研发计划资助项目(2016YFC0900605);河北省医学科学研究课题(20190108);唐山市科技计划(18130206a)。

摘　　要：目的观察酸性哺乳动物几丁质酶(AMCase)在矽肺模型大鼠肺组织和尘肺病患者支气管肺泡灌洗液(BALF)、血清中的表达,评价AMCase对尘肺病早期诊断的价值。方法 (1)将无特定病原体级成年雄性Wistar大鼠随机分对照组和模型组,每组15只;模型组大鼠采用动式吸入染尘法,予质量浓度为2 000.0 mg/m^(3)的游离二氧化硅粉尘每天染尘3 h,对照组大鼠不予染尘处理;2组大鼠分别于染尘第4、12和24周各处死5只。(2)采用随机数表法,选择191例进行大容量肺灌洗的职业性尘肺病患者为尘肺病组,选择12例进行大容量肺灌洗的粉尘作业人员为粉尘对照组,选择200名有粉尘作业史的健康煤矿工人为健康对照组。(3)采用蛋白免疫印迹法检测大鼠肺组织中AMCase、Ⅰ型胶原(COLⅠ)、α-平滑肌肌动蛋白(α-SMA)相对表达水平和人BALF中AMCase相对表达水平;采用酶联免疫法检测人血清AMCase水平;采用受试者工作特征(ROC)曲线评价血清AMCase蛋白水平对于尘肺病的早期诊断价值。结果模型组大鼠肺组织AMCase、COLⅠ和α-SMA蛋白相对表达水均高于对照组(P值均<0.01)。尘肺病组和尘肺病壹期、贰期、叁期亚组人群BALF中AMCase蛋白相对表达水平均高于粉尘对照组(P值均<0.05),血清AMCase蛋白水平均高于健康对照组(P值均<0.05)。ROC曲线分析结果显示:采用血清AMCase蛋白水平预测尘肺病的ROC曲线下面积为0.78(95%可信区间为0.74~0.82);当血清AMCase蛋白水平截断值为466.0 ng/L时,灵敏性为73.8%,特异性为72.6%。结论血清AMCase蛋白对于尘肺病早期诊断具有一定价值,可能是潜在的尘肺病早期诊断生物标志物。Objective To observe the expression of acidic mammalian chitinase(AMCase) in lung tissue of silicosis model rats, and bronchoalveolar lavage fluid(BALF) and serum of patients with occupational pneumoconiosis, and to evaluate the value of AMCase in the early diagnosis of pneumoconiosis. Methods i) The specific pathogen free adult male Wistar rats were randomly divided into control group and model group, with 15 rats in each group. The rats in the silicosis model group was exposed to free silica dust with a concentration of 2 000.0 mg/m^(3) by dynamic inhalation for three hours a day, while the rats in control group were not exposed to dust. Five rats in the two groups were sacrificed at 4, 12 and 24 weeks after dust exposure. ii) By random number table method, a total of 191 patients with occupational pneumoconiosis who received large capacity lung lavage were selected as the pneumoconiosis group, 12 dust-exposed workers who received large capacity lung lavage were selected as the dust control group, and 200 healthy coal miners exposed to dust were selected as healthy control group. iii) Western blotting was used to detect the relative protein expression of AMCase, type Ⅰ collagen(COLⅠ), α-smooth muscle actin(α-SMA) in lung tissues of the rats and the relative protein expression of AMCase in human BALF. Enzyme linked immunosorbent assay was used to detect the level of AMCase protein in human serum. Receiver operating characteristic(ROC) curve was used to evaluate the value of AMCase protein level in human serum for early diagnosis of pneumoconiosis. Results The relative expression of AMCase, COLⅠand α-SMA protein in lung tissue of rats in the silicosis model group were higher than that of control group(all P<0.01). The relative expression of AMCase protein in BALF of pneumoconiosis group and pneumoconiosis stage Ⅰ, Ⅱ and Ⅲ subgroups were higher than that of dust control group(all P<0.05). The level of AMCase protein in serum of pneumoconiosis group and pneumoconiosis stage Ⅰ, Ⅱ and Ⅲ subgroups

关 键 词：酸性哺乳动物几丁质 二氧化硅 矽肺 尘肺病 Ⅰ型胶原 α-平滑肌肌动 ROC曲线 诊断价值 

分 类 号：R135.2[医药卫生—劳动卫生]