去甲肾上腺素水平在胸腔积液鉴别诊断及预后评估中的价值

The application value of norepinephrine levels in differential diagnosis and prognosis evaluation of patient with pleural effusion

目的:探究胸腔积液中能够提示患者临床诊断与预后的潜在生化指标,为临床诊断与治疗提供帮助。方法:收集郑州大学第一附属医院2020年4月至2021年5月41例患者的胸腔积液样本,采用流式细胞术检测肿瘤相关巨噬细胞(tumor-associated macrophages,TAMs)比例,酶联免疫吸附测定(enzyme linked immunosorbent assay,ELISA)检测乳酸、去甲肾上腺素(norepinephrine,NE)水平,同时收集临床检测乳酸代谢相关分子乳酸脱氢酶(lactate dehydrogenase,LDH)结果,结合患者临床诊断与预后情况,通过独立样本t检验、逻辑回归分析、ROC分析等方法分析其与良恶性胸腔积液鉴别诊断及患者预后之间的关联。结果:恶性胸腔积液(malignant pleural effusion,MPE)中NE的水平明显高于非恶性胸腔积液(non-malignant pleural effusion,NMPE)[(5.24±3.49)ng/mL vs.(2.56±2.25)ng/mL,P<0.05];且NE水平与恶性病理诊断呈正相关(P<0.05);ROC曲线分析NE水平作为良恶性诊断指标的曲线下面积(area under curve,AUC)为0.751。NE水平、TAMs比例与较差预后也具有相关性(P<0.05),其作为预后评估指标的ROC曲线AUC分别为0.837,0.856(P<0.05);当NE与TAMs比例、乳酸水平联合时,联合指标作为预后判断指标的ROC曲线的AUC达0.928(P<0.05),相比NE、TAMs单因素更高,对预后预测的价值进一步提高。结论:胸腔积液中NE水平与恶性病理诊断具有相关性,可作为辅助良恶性鉴别诊断的潜在指标。此外,恶性胸腔积液中NE水平与不良预后联系紧密,也可作为患者预后评估的指标;当其与TAMs、乳酸联合时,对预后预测准确性更高。

Objective:To explore the potential biomarkers in pleural effusion that are correlated with diagnosis and guide clinical diagnosis and treatment.Methods:Pleural effusion samples were collected from patients treated at The First Affiliated Hospital of Zhengzhou University from April 2020 to May 2021.Tumor-associated macrophages(TAMs)were examined using flow cytometry;lactate and norepinephrine(NE)levels were tested using enzyme-linked immunosorbent assay;and lactate dehydrogenase(LDH)levels were acquired from test results provided by the hospital.The correlations between TAMs;lactate,LDH,and NE levels;clinical diagnosis;and prognosis were analyzed.Results:The NE level in malignant pleural effusion(MPE)samples was significantly higher than that in non-malignant pleural effusion(NMPE)samples[(5.24±3.49)ng/mLvs.(2.56±2.25)ng/mL,P<0.05],and positively correlated with malignancy(P<0.05),with an area under the receiver operating characteristic curve(AUC)of 0.751(P<0.05).NE level and TAMs percentage in MPE were positively associated with poor clinical outcomes(P<0.05),with an AUC of 0.837 and 0.856 for poor prognosis,respectively(P<0.05).The combination of TAMs and lactate and NE levels were more accurate in predicting clinical outcomes,with an AUC of 0.928(P<0.05).Conclusions:NE is a promising novel diagnostic and prognostic biomarker for malignancy whose ability to predict clinical outcomes is improved when combined with TAMs and lactate levels.