特异性肺纤维化和体液免疫指标对尘肺病晋期诊断价值分析

Analysis on diagnostic value of specific pulmonary fibrosis and humoral immune indexes in progression of pneumoconiosis stage

目的探讨特异性肺纤维化和体液免疫指标对于尘肺晋期进展的辅助诊断价值。方法以2005年1月至2014年1月在本院住院的尘肺病患者为研究对象,根据是否晋期分为晋期组(27例)与对照组(27例),收集2组患者首次诊断和晋期诊断时的特异性肺纤维化指标血管紧张素转化酶(ACE)、单胺氧化酶(MAO)、铜蓝蛋白(CP)和体液免疫指标免疫球蛋白(Ig)A、IgG、IgM、补体3(C3)、补体4(C4)、C反应蛋白(CRP)的检查结果。计量资料采用以中位数和第25、75百分位数描述,采用秩和检验和二分类非条件Logistic回归分析进行统计分析。结果晋期组晋期诊断时ACE活力和CP、C3、C4、IgG水平均高于首次诊断[94.00(69.00,123.00)vs 68.00(46.80,89.00)U/L,322.90(274.00,411.80)vs 283.80(248.00,336.00)mg/L,1.33(1.16,1.51)vs 1.12(0.93,1.31)g/L,0.33(0.28,0.37)vs 0.28(0.22,0.34)g/L,12.31(10.56,14.14)vs 10.24(9.08,11.90)g/L,P<0.05)]。晋期组晋期诊断时与首次诊断时的ACE、C3、C4和IgG的指标差值分别高于对照组相应的指标差值[30.00(-2.50,44.20)vs-8.00(-42.00,11.00)U/L,0.20(0.12,0.31)vs-0.14(-0.29,0.06)g/L,0.05(-0.01,0.08)vs0.01(-0.02,0.04)g/L,1.02(-0.61,3.81)vs 0.70(-3.59,1.53)g/L,P<0.05)]。Logistic回归分析结果显示,晋期诊断和首次诊断时C3和ACE的指标差值越大者,发生尘肺病晋期的危险性越高(P<0.05)。结论晋期组患者存在肺纤维化持续加重和体液免疫亢进。特异性肺纤维化和体液免疫指标对尘肺晋期进展的辅助诊断有一定价值,需要动态监测、综合分析。

Objective To explore the auxiliary diagnosis value of specific pulmonary fibrosis and humoral immune indexes in the progression of pneumoconiosis stage. Methods Totally 54 inpatients of pneumoconiosis from January 2005 to January2014 were selected as the research objects. They were divided into progression group（27 cases） and control group（27cases） according to the diagnostic conclusion of the pneumoconiosis stage progressing or not. The patients＇ specific pulmonary fibrosis indexes at the first diagnosis stage and at the progression diagnosis stage were observed,including angiotensin converting enzyme（ACE）,monoamine oxidase（ MAO）,ceruloplasmin（ CP） and humoral immune indexes of immune globulin（Ig） A,IgG,IgM,complement 3（ C3）,complement 4（ C4）,C-reactive protein（ CRP）. The measurement data were described as median,the twenty-fifth percentile and the seventy-fifth percentile. Rank-sum test and binary unconditional Logistic regression analysis were used for statistical analysis. Results In the progression group,the activity of ACE,the levels of CP,C3,C4 and IgG in progression diagnosis stage were significantly higher than those of the first diagnosis stage respectively [94. 00（69. 00,123. 00） vs 68. 00（46. 80,89. 00） U /L,322. 90（274. 00,411. 80） vs 283. 80（248.00,336.00） mg/L,1.33（1.16,1.51） vs 1.12（0.93,1.31） g/L,0.33（0.28,0.37） vs 0.28（0.22,0.34） g/L,12. 31（10. 56,14. 14） vs 10. 24（ 9. 08,11. 90） g /L,P 0. 05）]. The index differences of ACE,C3,C4 and IgG between the progression diag-nosis and the first diagnosis stage in the progression group were significantly higher than those in the control group respectively [30. 00（- 2. 50,44. 20） vs- 8. 00（- 42. 00,11. 00） U /L,0. 20（0. 12,0. 31） vs- 0. 14（- 0. 29,0. 06） g /L,0. 05（- 0. 01,0. 08） vs 0. 01（- 0. 02,0. 04） g /L,1. 02（- 0. 61,3. 81） vs 0. 70（- 3. 59,1. 53） g /L,P〈0.05）]. Logistic regression analysis showed that the higher the index differences of C3,ACE and CP,higher the risk of the progression of pneumoconiosis respectively（P〈0. 05）. Conclusion The patients in the progression group have hyperfunctional pulmonary fibrosis and hyper-humoral immune function. Specific pulmonary fibrosis and humoral immune indexes have some values on auxiliary diagnosis of pneumoconiosis progression,which needs dynamic monitoring and comprehensive analysis.