血清CGRP、MMP-9和T、NK细胞及免疫球蛋白对脑卒中并发肺部感染患者的诊断价值

The diagnostic value of serum CGRP, MMP-9, T cells, NK cells and immunoglobulin in stroke patients with pulmonary infection

目的应用ROC曲线评价血清降钙素基因相关肽(CGRP)、基质金属蛋白酶-9(MMP-9)和T淋巴细胞亚群、自然杀伤细胞(NK细胞)及免疫球蛋白对脑卒中并发肺部感染患者的诊断价值。方法选择2015年11月至2019年3月在我院神经内科接受治疗的68例老年脑卒中并发肺部感染患者作为感染组,另选取同期未并发肺部感染的46例老年脑卒中患者作为非感染组。比较两组患者的临床资料,检测并比较两组患者血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、CGRP、MMP-9和T细胞、NK细胞及免疫球蛋白水平,应用受试者工作特征(ROC)曲线分析各指标对脑卒中并发肺部感染的诊断价值。结果(1)感染组与非感染组患者年龄、性别、病种、基础疾病比较差异均无统计学意义(均P>0.05),感染组患者神经功能缺损评分(NIHSS)、急性生理功能和慢性健康状况评分系统(APACHE)Ⅱ评分均显著高于非感染组(均P<0.05)。(2)感染组患者血清hs-CRP、PCT、IL-6水平均显著高于非感染组,CD3^+、CD4^+、CD4^+/CD8^+、CD16^++CD56^++NK细胞水平均显著低于非感染组(均P<0.05),两组患者CD8^+细胞水平比较差异无统计学意义(P>0.05);感染组患者IgG水平显著低于非感染组(P<0.05),两组患者IgA、IgM水平比较差异无统计学意义(均P>0.05);感染组患者血清CGRP水平显著低于非感染组,MMP-9水平则显著高于非感染组(均P<0.05)。(3)ROC曲线分析显示血清CGRP、MMP-9、PCT和CD16^++CD56^++NK细胞对脑卒中并发肺部感染的诊断效能较高,4个指标联合检测的AUC为0.937,其灵敏度和特异度为92.5%和96.3%。结论脑卒中合并肺部感染患者血清IL-6、PCT、hs-CRP、MMP-9水平升高,CGRP、T细胞、NK细胞及免疫球蛋白水平降低。血清PCT、CGRP、MMP-9和CD16^++CD56^++NK细胞对脑卒中并发肺部感染的诊断效能较高,4项指标联合检测能显著提高疾病早期诊断的敏感度和特异度。

Objective To evaluate the diagnostic value of serum calcitonin gene-related peptide(CGRP),matrix metalloproteinase-9(MMP-9),T lymphocyte subsets,natural killer cells(NK cells)and immunoglobulin in stroke patients with pulmonary infection by using ROC curve.Methods Sixty-eight 68 elderly stroke patients with pulmonary infection were enrolled as the infection group,and 46 elderly stroke patients without pulmonary infection during the same period as the non-infection group.The clinical data of the two groups were compared.The levels of serum procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),CGRP,MMP-9,T cells,NK cells and immunoglobulin were detected and compared between the two groups.The diagnostic value of these indexes was analyzed using ROC curve.Results(1)There were no significant differences in age,sex,disease type and underlying disease between the two groups(all P>0.05).The scores of NIHSS and APACHE II in infection group were significantly higher than those in non-infection group(all P<0.05).(2)The levels of serum hs-CRP,PCT and IL-6 inflammatory factors in the infection group were significantly higher than those in the non-infection group.The levels of T lymphocyte subsets CD3^+,CD4^+,CD4^+/CD8^+and CD16^++CD56^++NK cells in the infection group were significantly lower than those in the non-infection group(Ps<0.05).There was no significant difference between the two groups in CD8^+level(P>0.05).The level of immunoglobulin IgG in the infection group was significantly lower than that in the non-infection group(P<0.05).There were no significant differences in IgA and IgM between the two groups(Ps>0.05).The serum CGRP in the infection group was significantly lower,while MMP-9 was significantly higher than in the non-infection group respectively(all P<0.05).(3)ROC curve analysis showed that serum CGRP,MMP-9,PCT and CD16^++CD56^++NK cells had better efficacy in the diagnosis of stroke concomitant pulmonary infection.The AUC of combined detection of the four indicators was 0.937,with the sensitivity and specificity of 92.5%and 96.3%respectively.Conclusion The IL-6,PCT,hs-CRP and MMP-9 increased while CGRP,T cells,NK cells and immunoglobulin decreased in stroke patients with pulmonary infection.According to ROC curve analysis,serum PCT,CGRP,MMP-9 and CD16^++CD56^++NK cells were more effective than other indicators in the diagnosis of pulmonary infection in stroke patients,and the combined detection of the four indicators can significantly improve the sensitivity and specificity of early diagnosis of the disease.