胰石蛋白在呼吸机相关性肺炎患者支气管肺泡灌洗液及呼出气冷凝液中的表达及检测价值

Expression of pancreatic stone protein in bronchoalveolar lavage fluid and exhaled breath condensate of patients with ventilator-associated pneumonia and its detection value

目的观察胰石蛋白(PSP)在呼吸机相关性肺炎(VAP)患者支气管肺泡灌洗液(BALF)及呼出气冷凝液(EBC)中的表达并探讨其检测价值。方法采用酶联免疫吸附法(ELISA)分别检测40例VAP患者VAP疑诊当日及VAP诊断当日BALF、EBC中的PSP表达水平,同期选择40例行机械通气治疗而未出现VAP的患者作为对照组。比较2组患者不同时点BALF、EBC中PSP表达水平,采用受试者工作特征(ROC)曲线法分析BALF、EBC中PSP水平检测对VAP的诊断价值。结果VAP组患者疑诊当日、诊断当日的BALF、EBC中PSP表达水平均显著高于对照组(P<0.05),2组患者VAP诊断当日的BALF、EBC中PSP表达水平均显著高于VAP疑诊当日(P<0.05),2组患者同时点的BALF中PSP表达水平均显著高于EBC(P<0.05);VAP诊断当日BALF中PSP的曲线下面积为0.91,高于VAP诊断当日EBC中PSP和VAP疑诊当日BALF、EBC中PSP的曲线下面积,虽然灵敏度(87.50%)低于EBC中PSP(92.50%),但特异度(80.00%)高于EBC中PSP(67.50%)。结论检测BALF、EBC中PSP水平对于VAP早期诊断具有较高的临床价值,尤其是BALF中PSP水平检测的价值更高。

Objective To observe the expression of pancreatic stone protein (PSP) in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) of patients with ventilator-associated pneumonia (VAP) and its detection value. Methods The PSP expression levels in BALF and EBC of 40 VAP patients were respectively detected by enzyme-linked immunosorbent assay (ELISA) on the day of VAP suspected diagnosis and the day of VAP diagnosis. During the same period, 40 patients with mechanical ventilation without VAP were selected as the control group. The PSP expression levels in BALF and EBC between the two groups at different time points were compared, and the diagnostic value of PSP level in BALF and EBC for VAP diagnosis was analyzed by ROC curve method. Results The PSP expression levels in BALF and EBC on the day of VAP suspected diagnosis and the day of VAP diagnosis of the VAP group were significantly higher than that of the non-VAP group ( P <0.05). The PSP expression levels in BALF and EBC of both groups on the day of VAP diagnosis were significantly higher than those of the day of VAP suspected diagnosis ( P <0.05). The PSP expression levels in BALF of two groups were significantly higher than that in EBC ( P <0.05). The area under the curve of PSP in BALF on the day of VAP diagnosis was 0.91, which was higher than that in EBC on the same day, and that in EBC and BALF on the day of VAP suspected diagnosis. Although the sensitivity was lower than that in EBC(87.50% vs. 92.50%), and the specificity was higher than that in EBC (80.00% vs. 67.50%). Conclusion The detection of PSP levels in BALF and EBC for the early diagnosis of VAP has a higher clinical value, especially the detection of PSP levels in BALF.