正五聚体蛋白3在社区获得性肺炎临床诊断中的意义

doi:10.3969/j.issn.1673-8640.2020.05.006

摘要/Abstract

摘要：

目的探讨正五聚体蛋白3（PTX3）在社区获得性肺炎（CAP）诊断中的应用价值。方法选取CAP患者70例,根据患者病情分为重症CAP组和轻症CAP组;选取70名体检健康者作为对照组。收集所有对象C反应蛋白（CRP）、降钙素原（PCT）、白细胞（WBC）计数、中性粒细胞/淋巴细胞比值（NLR）等检测指标的结果。分别于患者入院24 h内、第3天、第7天采集患者外周静脉血,动态监测血清PTX3水平。比较不同组间患者各指标的相关性,分析PTX3的表达差异及动态变化情况。结果 CAP组患者PTX3、PCT、CRP水平高于对照组,差异有统计学意义（P<0.05）;而重症CAP组与轻症CAP组患者相比,PTX3、PCT、CRP升高情况也存在差异（P<0.05）。PTX3在临界值为31.28 ng/mL时诊断CAP患者的受试者工作特征（ROC）曲线的曲线下面积为0.714,敏感性为75.82%,特异性为77.18%。动态监测PTX3发现,重症CAP组患者各时间段PTX3水平均显著高于轻症CAP组患者（P<0.05）,2个组患者PTX3水平均随治疗时间延长而逐渐降低,但重症CAP组患者在第7天时仍维持在较高水平。CAP主要致病菌为细菌,不同病原体感染组患者之间PTX3水平无明显差异（P=0.296）。结论血清PTX3水平尤其是动态监测结果可以作为反应CAP的生物标志物,为临床提供有效的辅助诊断及疗效监测。

关键词: 正五聚体蛋白3, 社区获得性肺炎, 动态监测, 临床诊断, 重症肺炎, 疗效评估

Abstract:

Objective To evaluate the role of pentraxin-3（PTX3） in the diagnosis of community-acquired pneumonia（CAP）. Methods A total of 70 inpatients with CAP were enrolled,which were classified into severe CAP group and mild CAP group according to their condition. Totally,70 healthy subjects were enrolled as healthy control group. The results of C-reactive protein（CRP）,procalcitonin（PCT）,white blood cell（WBC） count and neutrophil/lymphocyte ratio（NLR） determinations were collected. Peripheral blood was collected within 24 h,on the 3rd day and the 7th day after admission,and serum PTX3 level was dynamically monitored. The correlation between different groups was compared,and the expression differences and dynamic changes of PTX3 were analyzed. Results PTX3,PCT and CRP in CAP group were higher than those in healthy control group（P<0.05）. Compared with mild CAP group,the increase of PTX3,PCT and CRP had statistical significance in severe CAP group（P<0.05）. The area under receiver operating characteristic（ROC） curve of PTX3 was 0.714,the sensitivity was 75.82%,and the specificity was 77.18%,when the cut-off value was 31.28 ng/mL. Dynamic monitoring of PTX3 showed that PTX3 level in severe CAP group was higher than that in mild CAP group（P<0.05）,and PTX3 levels in both groups gradually decreased with treatment time,but the PTX3 level in severe CAP patients remained at a high level on the 7th day. The main pathogen for CAP was bacteria,and there was no statistical significance in PTX3 level among the patients infected with different pathogens（P=0.296）. Conclusions Serum PTX3 level,especially the dynamic monitoring result,can be used as a biomarker for reflecting CAP,which can provide effective auxiliary diagnosis and efficacy monitoring for clinical practice.

Key words: Pentraxin-3, Community-acquired pneumonia, Dynamic monitoring, Clinical diagnosis, Severe pneumonia, Curative effect evaluation

中图分类号:

R446.1

朱红, 朱宇清, 顾国宝. 正五聚体蛋白3在社区获得性肺炎临床诊断中的意义[J]. 检验医学, 2020, 35(5): 424-427.

ZHU Hong, ZHU Yuqing, GU Guobao. Role of PTX3 in the diagnosis of community-acquired pneumonia[J]. Laboratory Medicine, 2020, 35(5): 424-427.

图/表 4

参考文献 16

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组别	例数	PTX3/（ng/mL）	PCT/（ng/mL）	CRP/（mg/L）	WBC计数/（10⁹/L）	NLR
重症CAP组	38	44.75（22.40~78.48）^*#	4.48（2.15~8.18） ^*#	89.52（56.33~154.29）^*#	11.94（5.66~19.82）^*#	6.08（4.81~9.06）^*#
轻症CAP组	32	24.62（9.51~42.47） ^*	2.22（1.09~5.92） ^*	45.14（23.48~84.28）^*	9.29（4.92~17.22）	4.97（3.44~8.72）^*
对照组	70	1.49 （0.92~2.25）	0.36（0.18~0.63）	3.67 （2.29~7.72）	6.18（3.91~9.40）	2.12（1.56~3.05）

组别	例数	PTX3/（ng/mL）	PCT/（ng/mL）	CRP/（mg/L）	WBC计数/（10⁹/L）	NLR
重症CAP组	38	44.75（22.40~78.48）^*#	4.48（2.15~8.18） ^*#	89.52（56.33~154.29）^*#	11.94（5.66~19.82）^*#	6.08（4.81~9.06）^*#
轻症CAP组	32	24.62（9.51~42.47） ^*	2.22（1.09~5.92） ^*	45.14（23.48~84.28）^*	9.29（4.92~17.22）	4.97（3.44~8.72）^*
对照组	70	1.49 （0.92~2.25）	0.36（0.18~0.63）	3.67 （2.29~7.72）	6.18（3.91~9.40）	2.12（1.56~3.05）

项目	AUC	最佳临界值	敏感性/ %	特异性/ %	P值
PTX3	0.714	31.28 ng/mL	75.82	77.18	<0.001
PCT	0.736	2.96 ng/mL	59.82	76.27	0.002
CRP	0.647	40.15 mg/L	71.48	68.74	0.008
WBC计数	0.522	8.91×10⁹/L	44.95	62.47	0.537
NLR	0.609	5.43	51.84	77.59	0.228

项目	AUC	最佳临界值	敏感性/ %	特异性/ %	P值
PTX3	0.714	31.28 ng/mL	75.82	77.18	<0.001
PCT	0.736	2.96 ng/mL	59.82	76.27	0.002
CRP	0.647	40.15 mg/L	71.48	68.74	0.008
WBC计数	0.522	8.91×10⁹/L	44.95	62.47	0.537
NLR	0.609	5.43	51.84	77.59	0.228