氨基酸水平鉴别AECOPD患者细菌感染与非细菌感染价值

Value of amino acid level in distinguishing bacterial infection and non-bacterial infection in AECOPD patients

目的分析血浆氨基酸水平对AECOPD患者细菌感染与非细菌感染鉴别价值。方法选择2018年2月~2019年在医院接受治疗的AECOPD患者78例(观察组)及同期健康体检者78例(对照组)进行研究。所有受试者抽取空腹外周静脉血2 ml,检测体内8种必须氨基酸与8种非必须氨基酸水平。观察组以痰培养结果分为感染组42例及非感染组36例。比较不同感染类型患者各氨基酸水平,并以ROC分析判断不同感染类型间具显著性差异的氨基酸对AECOPD患者细菌感染与非细菌感染的鉴别价值。结果两组调查对象苏氨酸、天冬酰胺、瓜氨酸、谷氨酰胺、组氨酸、蛋氨酸与丝氨酸水平差异均具有统计学意义(t=3.429、2.675、9.436、9.911、5.361、8.808、5.319,P<0.05)。细菌感染组患者苏氨酸、天冬酰胺、瓜氨酸、谷氨酰胺、组氨酸、蛋氨酸与丝氨酸水平均显著高于非细菌感染组(t=19.365、2.532、6.506、4.844、7.190、4.662、5.085,P<0.05)。ROC分析结果显示除天冬酰胺及蛋氨酸对AECOPD患者细菌感染与非细菌感染鉴别价值不具有统计学意义[曲线下面积(area under the curve,AUC)]=0.528、0.506,(P>0.05)外,苏氨酸、谷氨酰胺、瓜氨酸、组氨酸及丝氨酸对AECOPD患者细菌感染与非细菌感染鉴别均具有统计学意义且联合诊断可明显提高诊断效能(AUC=0.903、0.883、0.806、0.900、0.759、0.956,P<0.05)。结论苏氨酸、谷氨酰胺、瓜氨酸、组氨酸及丝氨酸可用于AECOPD患者细菌感染与非细菌感染的鉴别,且联合检测可提高诊断效能。

Objective To analyze the value of plasma amino acid levels in distinguishing bacterial infection and non-bacterial infection in AECOPD patients.Methods A total of 78 AECOPD patients(observation group)receiving treatment from February 2018 to 2019 in our hospital and 78 healthy subjects(control group)receiving physical examination during the same period were selected.All subjects were taken 2 ml of peripheral venous blood under fasting to detect the levels of eight essential amino acids and eight non-essential amino acids in the body.The observation group was divided into an infection subgroup(n=42)and a non-infection subgroup(n=36)according to the result of sputum culture.The levels of amino acids in patients with different infection types were compared.ROC analysis was used to determine the value of amino acids with significant differences between different types of infections for distinguishing bacterial and non-bacterial infections in AECOPD patients.Results The differences in the levels of threonine,asparagine,citrulline,glutamine,histidine,methionine and serine between the two subgroups were statistically significant(t=3.429,2.675,9.436,9.911,5.361,8.808,5.319;P<0.05).The levels of threonine,asparagine,citrulline,glutamine,histidine,methionine and serine in the bacterial infection group were significantly higher than those in the non-bacterial infection group(t=19.365,2.532,6.506,4.844,7.190,4.662,5.085;P<0.05).The results of ROC analysis showed that except for asparagine and methionine which had no statistical significance in the differential diagnosis of bacterial and non-bacterial infections in AECOPD patients(AUC=0.528,0.506;P>0.05),threonine,glutamine,citrulline,histidine and serine had statistical significance in distinguishing bacterial and non-bacterial infections in AECOPD patients,and the combined diagnosis could significantly improve the diagnostic efficiency(AUC=0.903,0.883,0.806,0.900,0.759,0.956;P<0.05).Conclusion Threonine,glutamine,citrulline,histidine,and serine can be used to distinguish between bacterial infections and non-bacterial infections in AECOPD patients,and combined detection can improve the diagnostic efficiency.