肾综合征出血热患者血清可溶性CD23、肝素结合蛋白表达与其病情严重程度和预后的关系

The relationship between the expression of serum soluble CD23 and heparin binding protein in patients with hemorrhagic fever with renal syndrome and its severity and prognosis

目的探究肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者血清可溶性CD23(soluble CD23,sCD23)、肝素结合蛋白(heparin binding protein,HBP)表达与其病情严重程度和预后的关系。方法纳入2012年9月至2016年1月中国人民解放军空军军医大学第二附属医院收治的123例HFRS患者为研究对象,依据临床分型标准,将其分为轻型组(21例)、中型组(32例)、重型组(30例)和危重型组(40例)。将同期于该院体检的健康者30例纳入对照组。采用双抗体夹心酶联免疫吸附测定检测HFRS患者急性期、恢复期和健康者的血清sCD23、HBP表达水平。观察血清sCD23、HBP在不同分型患者中的表达变化及其与对照组的差异。采用Pearson相关分析探讨HFRS患者血清sCD23、HBP与常规实验室指标的关系。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析sCD23、HBP和常规实验室指标对HFRS患者预后的预测效能。结果各型HFRS患者急性期血清sCD23、HBP表达水平均显著高于同型恢复期和对照组(均P<0.01),且血清sCD23、HBP表达水平均随着疾病加重而逐渐升高(均P<0.01);各型HFRS患者恢复期血清sCD23、HBP表达均显著高于对照组(均P<0.01),但各型间血清sCD23、HBP表达水平比较差异均无统计学意义(均P>0.05);Pearson相关分析结果显示,HFRS患者血清sCD23、HBP表达与活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,Fib)、白细胞(white blood cell,WBC)、血小板(platelet,PLT)、血红蛋白、血细胞比容、白蛋白(albumin,ALB)、血尿素氮、尿酸、谷丙转氨酶和谷草转氨酶(aspartate aminotransferase,AST)均具有相关性(均P<0.01),其中与APTT、Fib、WBC、PLT、ALB、AST相关性较强(均|rs|>0.50,均P<0.01)。ROC曲线显示,血清sCD23、HBP预测HFRS患者预后的曲线下面积分别为0.799(95%CI:1.415~9.408,P<0.01)、0.882(95%CI:1.440~14.627,P<0.01),二者联合的诊断效能最高。结论血清sCD23、HBP的异常表达与HFRS患者病情严重程度和预后密切相关,可作为疾病早期预测指标。

Objective To explore the relationship between the expression of serum soluble CD23(sCD23)and heparin binding protein(HBP)in patients with hemorrhagic fever with renal syndrome(HFRS)and the severity and prognosis of the disease.Method A total of 123 cases of HFRS patients admitted to Second Affiliated Hospital of Air Force Medical University,People’s Liberation Army from September 2012 to January 2016 were selected as the research objects.According to the clinical classification criteria,the patients were divided into mild group(n=21),moderate group(n=32),severe group(n=30)and critical group(n=40).Additionally,healthy individual during the same period was included as control group(n=30).The double-antibody sandwich enzyme-linked immunosorbent assay method was used to determine the serum sCD23 and HBP expression of HFRS patients during the acute phase,convalescent phase and also with the healthy controls.The expression of sCD23 and HBP among the four clinical types of HFRS patients and control group were observed.The relationship among serum sCD23,HBP and routine laboratory indexes in patients with HFRS were analyzed by Pearson correlation analysis.Receiver operating characteristic curve(ROC curve)was used to analyze the predictive efficacy of sCD23,HBP and routine laboratory indexes on the prognosis of patients with HFRS.Result Theexpression levels of sCD23 and HBP among the four clinical types of HFRS patients during acute phase were significantly higher than those of convalescent phase and control group(all P<0.01),the expression levels of sCD23 and HBP gradually increased with the severity of the disease(all P<0.01).The expression levels of sCD23 and HBP in HFRS patients during convalescent phase were also significantly higher than those of the control group(all P<0.01),while with no significant differences among the four clinical types(allP>0.05).The expression levels of sCD23 and HBP in HFRS patients were significantly correlated with activated partial thromboplastin time(APTT),fibrinogen(Fib),white blood cell(WBC),platelet(PLT),hemoglobin,hematocrit,albumin(ALB),blood urea nitrogen,uric acid,alanine aminotransferase and aspartate aminotransferase(AST)(all P<0.01),especially with APTT,Fib,WBC,PLT,ALB and AST(all|rs|>0.50,all P<0.01).The ROC curve analysis showed that the sCD23 and HBP had better predictive value on the prognosis of HFRS patients,with AUC of 0.799(95%CI:1.415~9.408,P<0.01)and 0.882(95%CI:1.440~14.627,P<0.01).At the same time,combined detection of sCD23 and HBP has the highest diagnostic efficiency.Conclusion The abnormal expression of serum sCD23 and HBP are closely related to the severity and prognosis of HFRS patients,which can be considered as early predictors of the disease.