SAA、CRP作为可溶性模式识别受体在非感染性疾病诊断中的价值

Values of SAA and CRP as soluble pattern recognition receptors in the diagnosis of non-infectious diseases

目的探讨可溶性模式识别受体血清淀粉样蛋白A(SAA)及血清C-反应蛋白(CRP)水平在非感染性疾病中的诊断价值,并绘制受试者工作特征(ROC曲线)找寻最佳临界值来辅助鉴别感染性疾病与非感染性疾病,为临床诊断提供依据。方法选择在湖南省第二人民医院住院部的91例非感染性疾病患者为非感染性疾病组。其中急性心肌梗死30例,急性胰腺炎30例,急性创伤31例。同时纳入感染组60例,健康对照组30例。通过检测以上3组的血清SAA、CRP水平,进行统计学分析。结果(1)非感染性疾病组、感染组与对照组血清CRP水平之间差异有统计学意义(χ^2=52.448,P<0.001),血清SAA水平差异有统计学意义(χ^2=43.993,P<0.001);(2)在非感染性疾病组中,各组与健康对照组间SAA、CRP水平差异有统计学意义(χ^2=53.534,P<0.001;χ^2=66.504,P<0.001)。SAA组间两两比较发现,急性心肌梗死、急性胰腺炎、急性创伤组与对照组比较差异有统计学意义(Z=-4.547、-6.409、-6.708,P=0.000),其中急性胰腺炎组与急性创伤组之间比较差异无统计学意义(Z=-0.15,P=0.88);CRP组间两两比较发现,急性心肌梗死组、急性胰腺炎组、急性创伤组与对照组比较差异有统计学意义(Z=-5.005、-5.287、-5.914,P=0.000),其中急性胰腺炎组与急性创伤组比较差异无统计学意义(Z=-0.15,P=0.286);(3)spearman相关分析可得出,血清SAA与CRP有一定相关性(r=0.649 4,P<0.000 1);(4)SAA、CRP单项检测诊断感染与非感染性疾病组的曲线下面积(AUC)分别为0.759、0.747;临界值分别为97.3mg/L、42.15mg/L;SAA、CRP联合检测诊断感染与非感染性疾病的AUC为0.765。结论血清中可溶性识别受体SAA、CRP在非感染性疾病中有较高表达,对于鉴别感染与非感染性疾病组有一定诊断效能,可以作为疾病分类的标志物。

Objective To explore the diagnostic value of soluble pattern recognition receptor-serum amyloid A(SAA)and serum C-reactive protein(CRP)levels in non-infectious diseases,and to draw ROC curves to find the optimal cut off value(cut off value)to assist in differentiating infectious diseases from non-infectious diseases,so as to provide basis for clinical diagnosis.Methods A total of 91 patients with non-infectious diseases were selected from the inpatient department of Hunan Second People′s Hospital.According to the clinical diagnosis,they were divided into three groups:30 cases of acute myocardial infarction,30 cases of acute pancreatitis and 31 cases of acute trauma.At the same time,60 cases were included in the infection group and 30 cases in the healthy control group.The serum levels of SAA and CRP in the above three groups were detected and analyzed statistically.Results(1)There were significant differences in serum CRP levels between the non-infectious diseases group,the infection group and the control group(χ^2=52.448,P<0.001).There were significant differences in serum SAA levels(χ^2=43.993,P<0.001);(2)There were significant differences in SAA and CRP levels between the non-infectious disease group and the healthy control group(χ^2=53.534,P<0.001;χ^2=66.504,P<0.001).Two or two comparisons between the SAA group and the control group showed significant differences(Z=-4.547,-6.40,-6.708,P=0.000),and there was no significant difference between the acute pancreatitis group and the acute trauma group(Z=-0.15,P=0.88);two comparisons between the CRP group showed that the acute myocardial infarction group,the acute pancreatitis group and the acute trauma group had no significant difference(Z=-0.15,P=0.88).There were significant differences between the two groups(Z=-5.005,-5.287,-5.914,P=0.000).There was no significant difference between the acute pancreatitis group and the acute trauma group(Z=-0.15,P=0.286);(3)Spearman correlation analysis showed that serum SAA was correlated with CRP(r=0.649 4,P<0.000 1);(4)SAA and CRP were 0.759 and 0.747 respectively for the diagnosis of infection and non-infection.The values of SAA and CRP were 97.30 mg/L and 42.15 mg/L respectively,and the AUC for diagnosis of infection and non-infection was 0.765.Conclusion The soluble recognition receptors SAA and CRP in serum are highly expressed in non-infectious diseases,which can be used as markers for the classification of infectious and non-infectious diseases.