白细胞介素6/8联合诊断在不同诱因引起慢性阻塞性肺疾病急性加重的应用价值

Clinical Value of Interleukin 6/8 Combined Diagnosis in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Caused by Different Inducements

目的:探究白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平及联合诊断在不同诱因引起慢性阻塞性肺疾病急性加重(AECOPD)的应用价值,为AECOPD患者用药指导提供依据。方法:选取2014年1月-2017年1月本院收治的COPD患者330例。将需接受治疗但COPD病情稳定的患者118例纳入稳定组,将AECOPD患者根据细菌病原学检测结果分为细菌组124例和非细菌组88例。检测并比较各组血清CRP、IL-6、IL-8及痰液IL-6、IL-8水平,比较各指标单独及联合诊断的特异性、敏感性、ROC曲线面积、阳性预测值、阴性预测值、约登指数(YI值),从而评价其在区分细菌组及非细菌组的诊断价值。结果:细菌组与非细菌组血清CRP、IL-6、IL-8及痰液IL-6、IL-8水平均高于稳定组,比较差异均有统计学意义(P<0.05);细菌组血清CRP、IL-6、IL-8及痰液IL-6、IL-8水平均高于非细菌组,比较差异均有统计学意义(P<0.05);血清联合诊断敏感度、ROC曲线面积、阳性预测值及YI值均高于血清IL-6、IL-8,比较差异均有统计学意义(P<0.05);其他检测方法的各个指标比较差异均无统计学意义(P>0.05);但痰液联合诊断的ROC曲线面积、YI值最高。结论:痰液联合诊断可以提高细菌感染及非细菌感染引起的AECOPD鉴别诊断效力,具有一定的诊断价值。

Objective：To explore the application value of interleukin-6（IL-6）,interleukin-8（IL-8） and joint diagnosis in acute exacerbation of chronic obstructive pulmonary disease（AECOPD） caused by different causes,and provide the basis for the guidance of drug use in AECOPD patients.Method：A total of 330 patients with COPD admitted to our hospital from January 2014 to January 2017 were selected.The patients who needed treatment but whose condition of COPD stable were included instable group（n=118）,and according to the results of bacterial etiological examination,the patients with AECOPD were divided into bacterial group（n=124） and non-bacterial group（n=88）.The levels of serum CRP,IL-6,IL-8 and sputum IL-6 and IL-8 were detected and compared.The specificity,sensitivity,area of ROC curve,positive predictive value,negative predictive value and Jorden index（YI value） were compared to evaluate the diagnostic value of the diagnosis of bacterial and nonbacterial groups.Result：The levels of serum CRP,IL-6,IL-8 and sputum IL-6 and IL-8 in bacterial group and non-bacterial group were higher than those of stable group,the differences were statistically significant（P〈0.05）.The levels of serum CRP,IL-6,IL-8 and sputum IL-6 and IL-8 in bacteria group were higher than those of nonbacteria group,the differences were statistically significant（P〈0.05）.The sensitivity,ROC curve area,positive predictive value and YI value in serum combined diagnosis were all higher than those of serum IL-6 and IL-8,the differences were statistically significant（P〈0.05）.The various indices of other detection methods were compared,the differences were not statistically significant（P〈0.05）.But ROC curve area and YI value of sputum combined diagnosis were the highest.Conclusion：The sputum combined diagnosis can improve the differential diagnostic efficacy of AECOPD caused by bacterial infection and non-bacterial infection,and has a certain diagnostic value.