肝素结合蛋白在感染性肺炎诊断中的价值分析

目的:探讨肝素结合蛋白(HBP)水平在感染性肺炎诊断中的临床应用价值。方法:选取2017年3月至12月在辽宁省人民医院收治的细菌性肺炎患者51例,非细菌性肺炎患者44例,选取同时期体检健康者51名作为健康人对照组。分别测定各组患者血液中HBP、血清淀粉样蛋白A(SAA)、降钙素原(PCT)及WBC水平,统计分析各指标组间差异;ROC曲线分析各指标对感染性肺炎的诊断效能。结果:血浆HBP水平在细菌性肺炎组52.00(25.00,101.00)ng/mL]显著高于非细菌肺炎组(12.14±6.46)ng/mL]和健康人对照组(11.86±5.14)ng/mL],差异有统计学意义(P<0.05);血浆HBP水平在非细菌性肺炎组和健康人对照组中差异无统计学意义(P>0.05)。细菌性肺炎组80.89(46.46,167.35)mg/L]、非细菌肺炎组11.86(2.06,52.56)mg/L]及健康人对照组(3.34±2.98)mg/L]各组间SAA水平比较,差异均有统计学意义(P<0.01);ROC曲线分析,HBP与SAA诊断细菌性肺炎的曲线下面积(AUC)分别是0.917和0.834,当HBP诊断阈值为19.5 ng/mL时,诊断细菌性肺炎的敏感性和特异性分别为80.4%和88.4%;SAA诊断阈值为18.84 mg/L时,诊断细菌性肺炎的敏感性为78.4%,特异性为81.1%;联合HBP与SAA诊断细菌性肺炎的敏感性和特异性分别为90.2%和80.0%。HBP与SAA在鉴别诊断细菌性肺炎与非细菌性肺炎的AUC分别为0.908和0.748,当HBP=20.50 ng/mL和SAA=16.31 mg/L时,特异性分别为88.6%和54.5%。结论:血浆HBP是较敏感的细菌性感染标志物,在鉴别细菌与非细菌性肺炎中的诊断价值优于血清SAA、PCT及WBC,与血清SAA联合检测可提高诊断细菌性肺炎的敏感性。

Analysis for diagnostic value of heparin-binding protein in infectious pneumonia

Objective:To investigate the clinical application of heparin-binding protein(HBP)levels in infectious pneumonia.Methods:A total of 51 patients with bacterial pneumonia,44 patients with non-bacterial pneumonia and 51 controls in the Liaoning Province People′s Hospital from March to December 2017 were enrolled as the subjects in this study.The levels of HBP,serum amyloid A(SAA),procalcitonin(PCT)and white blood cell(WBC)in the blood samples of each group were measured respectively.The differences of the measured results among the various groups were statistically analyzed.The receiver operating characteristic(ROC)curve was established to analyze the diagnostic efficacy of HBP and SAA for infectious pneumonia.Results:The plasma level of HBP in bacterial pneumonia group52.00(25.00,101.00)ng/mL]was significantly higher than those of non-bacterial pneumonia group(12.14±6.46)ng/mL]and the healthy control group(11.86±5.14)ng/mL]with statistically significant differences(P<0.05).There were no statistically differences of the plasma HBP level between non-bacterial pneumonia group and control group(P>0.05).The level of SAA was 80.89(46.46,167.35)mg/L in the bacterial pneumonia group,11.86(2.06,52.56)mg/L in non-bacterial pneumonia group and(3.34±2.98)mg/L in healthy control group with statistically differences among the three groups(P<0.01).ROC curve analysis showed that the area under the curve(AUC)of HBP and SAA for diagnosis of bacterial pneumonia was 0.917 and 0.834 respectively.When the cut off value was 19.50 ng/mL,the sensitivity and specificity of HBP on the diagnosis of bacterial pneumonia were 80.4%and 88.4%respectively.When the cut off value was 18.84 mg/L,the sensitivity and specificity of SAA on the diagnosis of bacterial pneumonia were 78.4%and 81.1%respectively.The sensitivity and specificity of combination of HBP and SAA for the diagnosis of bacterial pneumonia were 90.2%and 80.0%respectively.When HBP=20.50 ng/mL and SAA=16.31 mg/L,the AUC of differential diagnosis for bacterial pneumonia and non-bacterial pneumonia by HBP and SAA were 0.908 and 0.748 respectively.The specificities of HBP and SAA for differential diagnosis of bacterial and non-bacterial pneumonia were 88.6%and 54.5%respectively.Conclusion:Plasma HBP should be a sensitive marker for bacterial infection.The diagnostic value of HBP for the differentiation between bacterial and non-bacterial pneumonia is superior to SAA,PCT and WBC.The combined detection of HBP and SAA could improve the sensitivity for diagnosis of bacterial pneumonia.