感染相关炎性因子检测在慢性阻塞性肺疾病伴肺炎中的诊断价值

Value of infection-related inflammatory factors in diagnosis of pneumonia combined with chronic obstructive pulmonary disease

目的探讨白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、α1-酸性糖蛋白(AAG)在慢性阻塞性肺疾病(COPD)伴肺炎中的表达变化和诊断价值。方法选取2009年9月-2010年9月住院患者72例,健康对照19例,按COPD无、缓解期、急性加重期和肺炎有、无两种因素组合分为6组,酶联免疫吸附试验检测其血清IL-8、TNF-α含量,免疫比浊法检测血清AAG含量,双因素协方差分析其差异,并用ROC曲线比较评估其在肺炎中的价值。结果 COPD疾病进展中IL-8、TNF-α、AAG存在升高,并且肺炎患者高于未伴肺炎患者,差异有统计学意义(P<0.01);ROC曲线显示,TNF-α的曲线下面积(AUC)(0.928,95%CI为0.869～0.987),高于IL-8的AUC(0.910,95%CI为0.846～0.974)和AAG的AUC(0.719,95%CI为0.606～0.833);IL-8的敏感性、特异性、阳性预测值、阴性预测值分别为81.4%、100.0%、100.0%、85.7%;TNF-α的敏感性、特异性、阳性预测值、阴性预测值分别为88.4%、93.7%、100.0%、82.8%;AAG的敏感性、特异性、阳性预测值、阴性预测值分别为58.1%、93.7%、86.2%、71.0%。结论 COPD患者中,TNF-α是诊断肺炎的较佳指标。

OBJECTIVE To discuss the relationships between serum levels of interleukin-8（IL-8）,tumor necrosis factor-α（TNF-α）,α1-acidglycoprottin（AAG） and combination of chronic obstructive pulmonary disease（COPD） and pneumonia.METHODS From Sep 2009 to Sep 2010,a total of 72 patients and 19 healthy individuals were selected and divided into 6 groups by 2 factors：pneumonia and COPD.Serum levels of IL-8,TNF-α were detected by enzyme linked immunosorbent assay（ELISA） and serum levels of AAG were detected by immunoturbidimetry.The forecast values of pneumonia was analyzed by receiver operator characteristic（ROC） curve.RESULTS Serum levels of IL-8,TNF-α,AAG increased not only in the progress of COPD but also in patients with pneumonia as compared with the patients without pneumonia（P0.01）.The area under receiver characteristic curves（AUC） of serum levels of TNF-α（0.928,95% CI 0.869～0.987） were higher than the AUC of serum levels of IL-8（0.910,95% CI 0.846～0.974） and AAG（0.719,95% CI 0.606～0.833）.Sensitivity,specificity,positive predictive value and negative predictive value of IL-8 were 81.4%,100.0%,100.0%,and 85.7%;sensitivity,specificity,positive predictive value,and negative predictive value of TNF-α were 88.4%,93.7%,100%,and 82.8%;the sensitivity,specificity,positive predictive value,and negative predictive value of TNF-α were 58.1%,93.7%,86.2% and 71.0%,respectively.CONCLUSION The present data reveals that serum level of TNF-α is of great value in diagnosis of pneumonia in patients with COPD.