社区获得性肺炎血清可溶性选择素和细胞黏附分子水平测定

Serum Levels of Soluble Selectins and Soluble Adhension Molecules in Patients with Community Acquired Pneumonia

目的探讨测定社区获得性肺炎(CAP)血清可溶性选择素(sE-SLT和sP-SLT)、可溶性黏附分子-1(sICAM-1和sVCAM-1)的临床意义。方法使用酶联免疫吸附试验(ELISA)动态检测25例CAP患者治疗前后及10例对照组血清sE-SLT、sP-SLTs、ICAM-1、sVCAM-1的水平,并与临床C反应蛋白(CRP)、中性粒细胞碱性磷酸酶积分(NAP)、中性粒细胞计数和临床感染评分(CPIS)进行相关性分析。结果肺炎组急性期sE-SLT、sP-SLTs、ICAM-1、sVCAM-1水平分别为2.4622±0.2963,2.2036±0.23317,2.6584±0.2597,2.6809±0.2554ng/mL,皆高于对照组(P<0.01),治疗后各指标水平降至正常。各炎症指标中,CRP与临床感染评分(CPIS)的相关性最佳(r=0.710,P<0.001),sICAM-1、sE-SLT与中性粒细胞计数及CPIS评分正相关(r=0.592,P<0.01;r=0.256,P<0.05;r=0.358,P<0.01;r=0.222,P=0.05),sP-SLT、sVCAM-1与CRP、NAP、中性粒细胞计数及CPIS皆未见明显相关。sE-SLTs、P-SLT两选择素之间及sICAM-1、sVCAM-1两黏附分子之间存在相关性,而选择素与黏附分子之间未见明显相关。结论sE-SLT、sICAM-1水平sP-SLT、sVCAM-1能较好地反映CAP的病情及严重程度。

Objective To study the serum levels of soluble E-selectin （sE-SLT）,soluble P-selectin （sP-SLT）, soluble intercellular adhension molecule-1 （slCAM-1）and soluble vascular cell adhension mole- cule-1 （sVCAM-1） in patients with community acquired pneumonia （CAP） and their clinical significance. Methods Serum sE-SLT, sP-SLT, sICAM-1 and sVCAM-1 were detected by ELISA in 25 Patients with CAP, before and after treatment. C-reaction protein （CRP）, Neutrophil Alkaline Phosphatase （NAP） score, the number of neutrophil and clinical pulmonary infection score（CPIS） were analysed. Results Before treatment, the levels of sE-SLT, sP-SLT,slCAM-1 and sVCAM-1 were 2. 4622±0. 2963, 2. 2036±0. 23317, 2. 658±0. 2597, 2. 6809±0. 2554 ng/mL respectively in the patients with acute CAP, significantly higher than those in controls （P〈0.01）. After treatment, all of them decreased significantly and were about the same levels as those in controls. CRP was the most sensitive factor among the com- mon inflammative indexs（r=0. 710,P〈0. 001）. The levels of both SE-SLT and slCAM-1 were posltively associated with the number of neutrophil and CPIS（r=0. 592,P〈0.01; r=0. 256,P〈0.05; r=0. 358,P 〈0.01; r=0.222, P=0.05 respectively）, but they were not associate with CPIS and NAP, the number of neutrophil and CRP. Conclusion The levels of both SE-SLT, sP-SLT and sICAM-1, sVCAM-1 may preferablely reflect the development and severity of CAP.