TNF-α、sTREM-1、IL-6、PCT在慢性阻塞性肺疾病伴肺炎诊断中的应用

摘要

目的：研究肿瘤坏死因子-α( TNF-α)、可溶性髓样细胞触发受体-1( sTREM-1)、白细胞介素-6(IL-6)、降钙素原(PCT)在慢性阻塞性肺疾病(简称慢阻肺)伴肺炎患者临床诊断中的意义。方法选择36例慢阻肺伴肺炎和30例慢阻肺不伴肺炎患者,通过ELISA法检测血清TNF-α、sTREM-1、IL-6、PCT表达水平,绘制ROC曲线分析确定四种细胞炎性因子诊断慢阻肺伴肺炎的临界值,并评价其特异性、敏感性及诊断效能。结果慢阻肺疾病进展中TNF-α、sTREM-1、IL-6、PCT存在升高,并且肺炎患者高于未伴肺炎患者,差异具有显著统计学意义(P<0．01)。慢阻肺伴肺炎患者中,加重期和缓解期的TNF-α、sTREM-1、IL-6、PCT表达水平均高于对照组,差异具有统计学意义( P<0．01),且加重期TNF-α、sTREM-1、PCT水平均高于缓解期,差异具有统计学意义(P<0．01)。伴肺炎患者中,加重期和缓解期TNF-α、sTREM-1、IL-6、PCT表达水平均高于未伴肺炎患者中其相应的组别,差异具有统计学意义(P<0．01)。 TNF-α、sTREM-1诊断COPD伴肺炎的临界值依次为124.54 ng/L、118.76 ng/mL,敏感性依次为89.5%、91．4%,特异性依次为92．6%、89．3%；通过比较ROC曲线下面积大小,提示TNF-α的诊断效能和sTREM-1接近。结论血清中TNF-α、sTREM-1水平测定有助于慢阻肺伴肺炎的临床诊断。%Objective To evaluate the significance of tumor necrosis factor-α ( TNF-α) , soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), interleukin-6 (IL-6) and procalcitonin (PCT) levels in the ser-um for the diagnosis of pneumonia complicated with chronic obstructive pulmonary disease ( COPD) . Methods En-zyme-linked immunosorbent assay (ELISA) was adopted to detect the levels of TNF-α, sTREM-1, IL-6 and PCT in serum of 36 patients with pneumonia complicated with COPD and 30 COPD patients. The receiver operating charac-teristic ( ROC) curves were used to detect the cut-off value and analyze the specificity, sensitivity and diagnostic effi-ciency. Results The serum levels of TNF-α, sTREM-1, IL-6 and PCT increased in both groups, and the increase was more pronounced in the COPD patients complicated with pneumonia than in the COPD group (P<0. 01). When the cut-off value of TNF-αand sTREM-1 were 124. 54 ng/L and 118. 76 ng/mL respectively, the sensitivity for TNF-αand sTREM-1 in the diagnosis of Tibetan tuberculous meningitis were 89. 5% and 91. 4%, the specificity for TNF-α and sTREM-1 were 92. 6% and 89. 3%, respectively. And the diagnostic efficiency of TNF-αwas similar to that of sTREM-1 by comparison the area under the curve. Conclusion The detection of TNF-α and sTREM-1 in serum is helpful in the diagnosis of pneumonia complicated with chronic obstructive pulmonary disease.