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| 血清内皮细胞特异性分子1与降钙素原联合检测在慢性阻塞性肺疾病急性加重细菌感染中的临床意义 |
| 胡小燕1,2,徐镶怀3,郑晓2,夏训和2,嵇华夏2,郑金旭1* |
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(1. 江苏大学附属医院呼吸与危重症医学科, 镇江 212001;
2. 上海市金山区亭林医院呼吸内科, 上海 201505;
3. 同济大学附属同济医院呼吸与危重症医学科, 上海 200065
*通信作者) |
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| 摘要: |
| 目的 探讨血清内皮细胞特异性分子1（ESM-1）与降钙素原（PCT）联合检测在细菌感染导致慢性阻塞性肺疾病急性加重（AECOPD）中的临床意义。方法 选择2019年1月至2021年12月在上海市金山区亭林医院呼吸内科住院治疗的AECOPD患者200例作为研究对象，依据痰培养报告分为两组：细菌性感染组113例、非细菌性感染组87例。以同期在上海市金山区亭林医院行健康体检的志愿者100例作为对照。采集AECOPD患者及健康对照组血清，用ELISA法检测血清ESM-1和PCT表达水平。绘制ROC曲线，评价ESM-1、PCT单独或两者联合检测对AECOPD细菌感染的诊断价值。结果 经抗感染治疗前，AECOPD细菌性感染组患者的血清ESM-1和PCT水平均高于AECOPD非细菌性感染组及健康对照组（P均＜0.05）；经抗生素治疗后，AECOPD细菌性感染的患者血清ESM-1和PCT表达水平均下降，与治疗前比较差异均有统计学意义（P均＜0.05）。用血清ESM-1、PCT单独诊断AECOPD细菌感染的AUC为0.902、0.828；ESM-1最佳临界值为1.326 μg/L，诊断AECOPD细菌感染的灵敏度为0.836，特异度为0.842；PCT最佳临界值为0.246 μg/L，诊断AECOPD细菌感染的灵敏度为0.542，特异度为0.982。两者联合诊断时的性能最优，AUC为0.953、灵敏度为0.886、特异度为0.952。结论 AECOPD患者细菌性感染时血清ESM-1及PCT的水平均升高，两者联合检测在提高细菌性感染的诊断率方面有潜在的临床价值和意义。 |
| 关键词: 慢性阻塞性肺疾病急性加重 内皮细胞特异性分子1 降钙素原 细菌性感染 |
| DOI：10.16781/j.CN31-2187/R.20220758 |
| 投稿时间：2022-09-27修订日期：2023-04-25 |
| 基金项目:上海市卫生健康委员会科研课题(201940280). |
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| Clinical significance of combined detection of serum endothelial cell-specific molecule 1 and procalcitonin in acute exacerbation of chronic obstructive pulmonary disease with bacterial infection |
| HU Xiaoyan1,2,XU Xianghuai3,ZHENG Xiao2,XIA Xunhe2,JI Huaxia2,ZHENG Jinxu1* |
(1. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu, China;
2. Department of Respiratory Medicine, Tinglin Hospital, Jinshan District, Shanghai 201505, China;
3. Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University, Shanghai 200065, China
*Corresponding author) |
| Abstract: |
| Objective To explore the clinical significance of combined detection of serum endothelial cell-specific molecule 1 (ESM-1) and procalcitonin (PCT) in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) caused by bacterial infection. Methods A total of 200 AECOPD patients who were hospitalized in Department of Respiratory Medicine, Tinglin Hospital, Jinshan District, Shanghai from Jan. 2019 to Dec. 2021 were selected. They were divided into 2 groups based on the sputum culture reports: bacterial-infected group (n＝113) and non-bacterial-infected group (n＝87). As a control group, 100 volunteers who underwent health examination in Tinglin Hospital, Jinshan District, Shanghai during the same period were selected. The levels of serum ESM-1 and PCT in each group were detected by enzyme-linked immunosorbent assay. The diagnostic value of serum ESM-1 and PCT alone or in combination for AECOPD with bacterial infection was evaluated by receiver operating characteristic curves. Results Before the anti-infection treatment, the levels of serum ESM-1 and PCT in the AECOPD bacterial-infected group were significantly higher than those in the AECOPD non-bacterial-infected group and healthy control group (all P＜0.05). After the antibiotic treatment, the expression levels of serum ESM-1 and PCT in the AECOPD bacterial-infected group were significantly decreased (both P＜0.05). The area under curve (AUC) values of serum ESM-1 and PCT alone in the diagnosis of AECOPD with bacterial infection were 0.902 and 0.828, respectively. The optimal critical value of ESM-1 was 1.326 μg/L, and the sensitivity and specificity in the diagnosis of AECOPD with bacterial infection were 0.836 and 0.842, respectively. The optimal critical value of PCT was 0.246 μg/L, and the sensitivity and specificity were 0.542 and 0.982, respectively. The best performance was achieved in the combination diagnosis with an AUC of 0.953, a sensitivity of 0.886, and a specificity of 0.952. Conclusion The levels of serum ESM-1 and PCT are increased in AECOPD patients with bacterial infection. The detection of serum ESM-1 combined with PCT has potential clinical value in improving the diagnosis rate of bacterial infection. |
| Key words: acute exacerbation of chronic obstructive pulmonary disease endothelial cell-specific molecule 1 procalcitonin bacterial infection |
