肝素结合蛋白在急性呼吸窘迫综合征诊断中的临床应用价值

发布时间：2018-03-10 02:39

本文选题：ARDS　切入点：肝素结合蛋白　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:采用酶联免疫吸附法检测肝素结合蛋白在急性呼吸窘迫综合征(ARDS)患者血液(血浆)中的表达水平,探讨定量检测肝素结合蛋白在临床中的诊断ARDS的应用价值,比较非ARDS患者、ARDS患者及严重ARDS患者血液中肝素结合蛋白与降钙素原、超敏C反应蛋白和IL-17在ARDS中的诊断意义。方法:采集20例健康志愿者,35例非ARDS患者,35例ARDS患者,35例严重ARDS患者的全血,采用酶联免疫吸附法(ELISA)对各实验组血浆进行肝素结合蛋白(heparin-bindingprotein,HBP)的定量测定,同时还结合了酶联荧光法检测血浆中的降钙素原(procalcitonin,PCT)水平、采用比浊法检测其中的超敏C反应蛋白(hs-CRP)水平,酶联免疫吸附法(ELISA)检测IL-17;将实验组和对照组血浆中各指标的检测结果进行统计、比较;绘制受试者操作特征曲线(receiver operating characteristic curve,ROC 曲线),并对曲线下的面积(area under the curve,AUC)进行计算,找出最佳的截断值,通过该值分析并比较HBP、PCT、hs-CRP和IL-17等在诊断ARDS时的灵敏度和特异度。结果:健康对照组、非ARDS组、ARDS组、严重ARDS组HBP各组间差异均有统计学意义(P0.01);ARDS组和严重ARDS组、健康对照组和非ARDS组间差别均有统计学意义(P0.01),严重ARDS组高于ARDS组,且组间差异有统计学意义(P0.05),非ARDS组与ARDS组差别无统计学意义(P=0.32);PCT水平各组间差异均有统计学意义(P0.01);hs-CRP各组间差异均有统计学意义(P0.01);IL-17各组间差异均有统计学意义(P0.01)。经ROC曲线分析显示HBP曲线下面积为0.772,且血浆中HBP浓度为11.5ng/m1时,其诊断ARDS的敏感度能达到76.1%,特异度高达78.8%。当HBP浓度达到19.6ng/m1时,其诊断严重ARDS的灵敏度为85.1%,特异度为89.8%。结论:血浆中HBP、PCT、hs-CRP和IL-17在临床上都可以作为ARDS的检测指标,且可以根据值的大小对患者病情进行评估。当HBP浓度达到30ng/m1时,其诊断严重ARDS的灵敏度和特异度分别为为85.1%和89.8%,可以作为ARDS良好的预警标志物,对于ARDS病情进展的监测作用很大。如果和患者血浆中的HBP,PCT和IL-17联合检测,对ARDS的预测效果更好。
[Abstract]:Objective: to detect the expression of heparin binding protein (heparin binding protein) in blood (plasma) of patients with acute respiratory distress syndrome (ARDS) by enzyme linked immunosorbent assay (Elisa), and to explore the value of quantitative detection of heparin binding protein in clinical diagnosis of ARDS. The levels of heparin binding protein and procalcitonin in the blood of non-ARDS patients and severe ARDS patients were compared. Diagnostic significance of hypersensitive C-reactive protein and IL-17 in ARDS methods: the whole blood samples of 35 patients with ARDS, 35 patients with ARDS and 35 patients with severe ARDS were collected from 20 healthy volunteers. The plasma heparin-binding protein (HBP) and procalcitonin (PCT) levels in plasma of each experimental group were determined by enzyme-linked immunosorbent assay (Elisa) and enzyme-linked fluorescence assay (Elisa). The levels of hypersensitive C-reactive protein hs-CRP and IL-17 were detected by turbidimetry and Elisa respectively. The receiver operating characteristic curve was drawn and the area area under the curveted under the curve was calculated to find the best truncation value. The sensitivity and specificity of IL-17 and hs-CRP in the diagnosis of ARDS were analyzed and compared. Results: there were significant differences between the healthy control group, the non-ARDS group, the severe ARDS group and the severe ARDS group in the diagnosis of ARDS. The difference between healthy control group and non ARDS group was statistically significant (P 0.01), and that in severe ARDS group was higher than that in ARDS group. There was no significant difference between ARDS group and ARDS group. There was significant difference in P0.01hs-CRP level among all groups. There was significant difference in P0.01hs-CRP level among all groups. There was a significant difference in P0.01IL-17 level among all groups. There was significant difference in P0.01hs-CRP level between all groups. There was a significant difference in P0.01hs-CRP level between all groups. There was significant difference in P0.01hs-CRP level between all groups. There was a significant difference in P0.01hs-CRP level between the two groups. The curve analysis showed that the area under the HBP curve was 0.772and the plasma HBP concentration was 11.5 ng / m ~ (-1). When the concentration of HBP reached 19.6 ng / ml, the sensitivity and specificity of HBP in the diagnosis of severe ARDS were 85.1 and 89.80.Conclusion: Hs-CRP and IL-17 in plasma can be used as a clinical index for the detection of ARDS, and its sensitivity is 76.1% and specificity is 78.80.When the concentration of HBP reaches 19.6ng / ml, the sensitivity is 85.1 and the specificity is 89.80.Conclusion: HBPT-hs-CRP and IL-17 in plasma can be used as indicators for the detection of ARDS. The sensitivity and specificity of HBP in the diagnosis of severe ARDS were 85.1% and 89.8, respectively, which could be used as a good early warning marker for ARDS. It can be used to monitor the progression of ARDS. If combined with HBPP-PCT and IL-17 in the plasma of patients, the prediction effect of ARDS is better.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.8

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