诺如病毒腹泻患者血清I-FABP、MIP-1α水平检测及诊断价值分析

Detection and diagnostic value of serum I-FABP and MIP-1αlevels in patients with Norovirus infected diarrhea

目的探讨诺如病毒感染性腹泻患者血清肠型脂肪酸结合蛋白(I-FABP)、巨噬细胞炎性蛋白-1α(MIP-1α)水平检测及诊断价值。方法纳入本院收治的诺如病毒感染性腹泻患者90例(诺如组),细菌感染性腹泻患者90例(细菌组)及健康志愿者90例(对照组)。酶联免疫吸附法检测血清I-FABP、MIP-1α水平,比较3组血清I-FABP、MIP-1α水平差异。诺如组根据脱水分型将其分为:无脱水(28例)、轻度脱水(37例)与严重脱水(25例),分析不同脱水分型患者血清I-FABP、MIP-1α及肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素(IL)-6水平。受试者工作特征(ROC)曲线评价血清I-FABP、MIP-1α对细菌感染性腹泻与诺如病毒感染性腹泻的鉴别价值,Pearson法分析血清I-FABP、MIP-1α水平与炎症因子水平相关性,多元线性回归分析诺如组血清I-FABP或MIP-1α水平的影响因素。结果对照组、诺如组及细菌组患者血清I-FABP[(2.57±0.43)ng/mL、(4.29±0.61)ng/mL、(5.22±0.70)ng/mL]、MIP-1α水平[(109.64±17.88)pg/mL、(173.52±19.05)pg/mL、(201.74±18.46)pg/mL]逐次升高(P<0.05)。ROC曲线显示,血清I-FABP、MIP-1α单独鉴别诺如病毒感染性腹泻与细菌性腹泻的截断值分别为4.97 ng/mL、191.59 pg/mL,AUC分别为0.836、0.884,准确度分别为78.33%、80.00%,而二者联合检测的AUC为0.950,准确度为87.22%,联合检测的AUC优于单独I-FABP、MIP-1α(Z/P=4.453/0.000、3.437/0.001)。与对照组相比,诺如组血清TNF-α、IL-6、CRP水平升高,与细菌组相比,诺如组血清TNF-α、IL-6、CRP水平降低(P<0.05)。无脱水患者血清I-FABP、MIP-1α、TNF-α、IL-6、CRP低于轻度脱水,轻度脱水患者血清I-FABP、MIP-1α及TNF-α、IL-6、CRP水平低于严重脱水(P<0.05)。相关性分析显示,诺如病毒感染性腹泻患者血清I-FABP、MIP-1α水平均与TNF-α、IL-6、CRP呈正相关(P<0.01)。多元线性回归分析,发现血清TNF-α升高、IL-6升高、CRP升高均是I-FABP、MIP-1α的影响因素(P<0.05)。结论诺如病毒感染性腹泻患者血清I-FABP、MIP-1α水平低于细菌性腹泻者,可用于鉴别诺如病毒感染性腹泻与细菌性腹泻,且二者均与炎症因子呈正相关,可能通过调控炎症反应参与诺如病毒感染性腹泻发病过程。

Objective To explore the detection and diagnostic value of serum intestinal fatty acid binding protein(IFABP)and macrophage inflammatory protein-1α(MIP-1α)levels in patients with Norovirus infected diarrhea.Methods Ninety patients with Norovirus infected diarrhea(norovirus group),90 patients with bacterial infectious diarrhea(bacterial group)and 90 healthy volunteers(control group)were enrolled in this hospital.Enzyme linked immunosorbent assay(ELISA)was applied to detect serum levels of I-FABP and MIP-1α,and the differences in serum levels of I-FABP and MIP-1αwere compared among the three groups.According to the dehydration type,the norovirus group was separated into:no dehydration(28 cases),mild dehydration(37 cases),and severe dehydration(25 cases),the serum levels of I-FABP,MIP-1α,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and interleukin-6 in patients with different dehydration types were analyzed.ROC curve was applied to evaluate the differential value of serum I-FABP and MIP-1αin bacterial diarrhea and Norovirus diarrhea,Pearson method was applied to analyze the correlation between serum I-FABP,MIP-1αlevels and inflammatory factor levels,multiple linear regression was applied to analyze the influencing factors of serum I-FABP or MIP-1αlevels in the norovirus group.Results The levels of serum I-FABP[(2.57±0.43)ng/mL,(4.29±0.61)ng/mL,(5.22±0.70)ng/mL]and MIP-1α[(109.64±17.88)pg/mL,(173.52±19.05)pg/mL,(201.74±18.46)pg/mL]in the control group,norovirus group,and bacterial group patients gradually increased(P<0.05).Receiver operating characteristic showed that the cutoff values of serum I-FABP and MIP-1αfor distinguishing Norovirus infected diarrhea and bacterial diarrhea were 4.97 ng/mL and 191.59 pg/mL respectively,the AUC was 0.836 and 0.884 respectively,and the accuracy was 78.33%and 80.00%respectively,while the AUC of the combined detection of the two was 0.950,and the accuracy was 87.22%,the joint detection of AUC was superior to individual I-FABP and MIP-1α(Z/P=4.453/0.000,3.437/0.001).Compared with the control group,the serum levels of TNF-α,IL-6,and CRP in the norovirus group increased,while compared with the bacterial group,the serum levels of TNF-α,IL-6,and CRP in the norovirus group decreased(P<0.05).The serum levels of I-FABP,MIP-1α,TNF-α,IL-6,and CRP in non dehydrated patients were lower than those in mild dehydrated patients,while the serum levels of I-FABP,MIP-1α,TNF-α,IL-6,and CRP in mild dehydrated patients were lower than those in severe dehydrated patients(P<0.05).Correlation analysis showed that the serum levels of I-FABP and MIP-1αin patients with Norovirus infected diarrhea were positively correlated with TNF-α,IL-6 and CRP(P<0.01).Multiple linear regression analysis showed that elevated serum TNF-α,IL-6,and CRP were all influencing factors for I-FABP and MIP-1α(P<0.05).Conclusion The serum levels of IFABP and MIP-1αin patients with Norovirus infected diarrhea are lower than those in patients with bacterial diarrhea,which can be used to differentiate Norovirus infected diarrhea from bacterial diarrhea,and both are positively related to inflammatory factors,and may participate in the pathogenesis of Norovirus infected diarrhea by regulating inflammatory response.