目的 探究中性粒细胞弹性蛋白酶（NE）检测在支气管扩张急性加重期患者合并铜绿假单胞菌（PA）感染中的临床意义。方法 选取2022年8月~2023年12月在本院接诊的支气管扩张急性加重期患者90例为研究组，根据痰培养结果鉴定出合并PA感染患者作为合并组（n=36），未合并PA感染但有其它细菌感染患者作为未合并组（n=54），另选择90例同期在本院进行支气管扩张稳定期门诊就诊患者为对照组，将其分为PA定植组（n=42）、无PA定植组（n=48）。检测血清NE及炎症指标降钙素原（PCT）、C反应蛋白（CRP）表达水平，采用Pearson法分析支气管扩张急性加重期患者血清NE水平与炎症指标的相关性；血清NE、PCT水平对支气管扩张急性加重期患者合并PA感染的预测效能采用ROC曲线进行分析。结果 研究组血清NE、PCT、CRP表达水平均明显高于对照组（P＜0.05）。PA定植组和无PA定植组血清NE、PCT、CRP表达水平比较，差异不显著（P＞0.05）。合并组血清NE、PCT、CRP水平均明显高于未合并组（P＜0.05）。气管扩张急性加重期患者血清NE水平与PCT、CRP水平呈正相关（P＜0.05）。血清NE、PCT、CRP及三者联合预测支气管扩张急性加重期患者合并PA感染的曲线下面积（AUC）分别为0.856、0.756、0.702、0.962，三者联合优于各自单独预测（Z二者联合-NE=2.399、Z二者联合-PCT=3.741，Z二者联合-CRP=4.499，P=0.017、P=0.000、P=0.000），其敏感度和特异度分别为80.56%、96.30%。结论 支气管扩张急性加重期患者血清NE水平显著升高，且与炎症指标PCT、CRP密切相关，三者联合对支气管扩张急性加重期患者合并PA感染有较高的预测效能。
Abstract
Objective To explore the clinical significance of detecting neutrophil elastase (NE) in patients with acute exacerbation of bronchiectasis complicated with Pseudomonas aeruginosa (PA) infection. Methods Ninety patients with acute exacerbation of bronchiectasis admitted to our hospital from August 2022 to December 2023 were regarded as the trail group. Based on sputum culture results, patients with concomitant PA infection but with other bacterial infections were identified as the combined group (n=36), while patients without concomitant PA infection were selected as the non-combined group (n=54). In addition, 90 patients who underwent stable bronchodilation outpatient visits in our hospital were regarded as the control group and divided into PA colonization group (n=42) and non-PA colonization group (n=48). The expression levels of serum NE, procalcitonin (PCT) and C-reactive protein (CRP) were detected. Pearson method was applied to analyze the correlation between serum NE level and inflammatory markers in patients with acute exacerbation of bronchiectasis. ROC curve was applied to evaluate the predictive efficacy of serum NE and PCT levels for PA infection in patients with acute exacerbation of bronchiectasis. Results The expression levels of serum NE, PCT, and CRP in the trail group were greatly higher than those in the control group (P<0.05).There were no significant differences in the expression levels of serum NE, PCT and CRP between the PA group and the non-PA group (P>0.05). The serum NE, PCT, and CRP levels in the combined group were greatly higher than those in the non-combined group (P<0.05). The serum NE level in patients with acute exacerbation of tracheal dilation was positively correlated with PCT and CRP levels (P<0.05). The area under the curve (AUC) of serum NE, PCT, CRP, and their combination in predicting PA infection in patients with acute exacerbation of bronchiectasis was 0.856, 0.756, 0.702, and 0.962, respectively. The combination of the three was better than their individual predictions (Z combination - NE=2.399, Z combination - PCT=3.741, Z combination - CRP=4.499, P=0.017, P=0.000, P=0.000), with sensitivity and specificity of 80.56% and 96.30%, respectively. Conclusion Serum NE level is greatly elevated in patients with acute exacerbation of bronchiectasis, and is closely related to inflammatory markers PCT and CRP. The combination of the three has a high predictive power for patients with acute exacerbation of bronchiectasis complicated with PA infection.
关键词
中性粒细胞弹性蛋白酶 /
铜绿假单胞菌 /
支气管扩张急性加重期 /
临床意义
Key words
Neutrophil elastase /
Pseudomonas aeruginosa /
Acute exacerbation of bronchiectasis /
Clinical significance
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