可溶性纤溶酶原激活物受体在社区获得性肺炎中的表达及临床意义
【摘要】 目的:探讨可溶性尿激酶型纤溶酶原激活物受体(suPAR)在成人社区获得性肺炎(CAP)住院患者中的表达及临床意义。方法:采用用酶联免疫吸附试验(ELISA)法测定61例住院CAP患者治疗前后及60例健康对照者的血浆suPAR水平,测定所有研究对象的CRP、WBC及PCT水平,CAP患者入院时进行肺炎CURB-65及APACHEⅡ评分,分析血浆suPAR与PCT、CRP、CURB-65、APACHEⅡ及住院时间的相关性。结果:肺炎治疗前suPAR、CRP、WBC及PCT水平均显著高于对照组,肺炎治疗后suPAR、CRP、WBC及PCT水平较治疗前显著降低,以上各项比较差异均有统计学意义(P
【关键词】 可溶性纤溶酶原激活物受体; 社区获得性肺炎; CURB-65评分; APACHEⅡ评分
Expression and Clinical Significance of suPAR in Patients with Community-Acquired Pneumonia/SUN Xun,ZHU Xue-chuang,HAO Yu-gui,et al.//Medical Innovation of China,2015,12(23):039-042
【Abstract】 Objective:To investigate the expression and clinical significance of soluble urokinase-type plasminogen activator receptor (suPAR) in patients with CAP. Method:The plasma suPAR levels of 61 adult patients with CAP and 60 healthy patients were measured by the method of enzyme-linked immunosorbent assay(ELISA).The levels of CRP、WBC and PCT of all research objects were measured.The APACHE Ⅱ and CURB-65 scores were evaluated when the patients were hospitalized.The relationship between plasma suPAR and PCT,CRP,CURB-65 score,APACHEⅡ score,length of stay were analyzed. Result:Before treatment,the suPAR,CRP、WBC and PCT levels in patients with CAP were significantly higher than those in the control group,after treatment,the suPAR,CRP、WBC and PCT levels of CAP patients were lower than before treatment,the differences above were all statistically significant(P 【Key words】 Soluble urokinase-type plasminogen activator receptor; Community-acquired pneumonia; CURB-65 score; APACHE Ⅱ score
First-author’s address:Zaozhuang Municipal Hospital,Zaozhuang 277100,China
社区获得性肺炎是最常见的感染性疾病,有很高的发病率和死亡率。在美国肺炎与流感是第九位的常见死亡原因,2010年约5万人死于肺炎[1]。及时、有效的抗生素治疗能降低发病率和死亡率,早期的诊断和病情严重程度的评估对CAP患者的治疗显得尤为重要。suPAR是尿激酶型纤溶酶原激活物受体(uPAR)的可溶形式,在某些感染性疾病(如菌血症、HIV感染)、肿瘤及一些慢性疾病(如肾病、肝病)中,血浆suPAR水平升高。近年研究发现,血浆suPAR水平的升高与疾病预后不良相关。本研究通过分析CAP患者血suPAR水平与其他炎症标记物及病情严重程度指标的相关性,评估suPAR对CAP患者危险分层和预后的价值。 目前关于suPAR的研究集中于系统性炎症反应综合征(SIRS)、脓毒血症等[9-10],且显示了作为新型炎症标记物的价值,而国内外未见在成人CAP中的研究报道。有在儿童CAP的研究显示,其血浆suPAR浓度明显高于健康个体,且与C-反应蛋白、住院时间呈正相关,重症患儿血浆suPAR水平明显高于非重症患儿[11]。Wrotek等[12]对儿童CAP的研究亦显示血浆suPAR水平与C-反应蛋白、PCT等呈正相关。这与本研究在成人CAP的研究一致。
本研究显示肺炎患者血浆suPAR增高,可能由于肺炎患者uPAR在白细胞中表达增高。而uPAR表达增加,进一步促进炎症细胞的趋化及渗出,有利于感染的清除。目前已有一些基础实验间接证明了这一点。在铜绿假单胞菌肺炎动物模型中,uPAR基因敲除小鼠与野生小鼠相比,中性粒细胞的募集能力明显下降,且uPAR基因敲除的小鼠,肺部中性粒细胞迁移减少[13-14]。Gyetko等[15]的研究表明细胞膜表面的uPAR可调节抗原致敏引起的淋巴细胞向肺部的募集。uPAR在白细胞中表达增高,uPAR从细胞表面脱落进入血液导致suPAR的增高。
总之,本研究发现血浆suPAR水平能够评估成人CAP的病情严重性,指导抗生素治疗。尽管本研究存在样本量小、未进行细菌学分析、未进行灵敏度及特异度分析的缺点,但本研究提示了suPAR可以作为CAP的炎性标记物,与其他标记物一起评估病情,指导诊疗。在成人CAP中,suPAR的价值今后尚需大规模前瞻性研究。
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(收稿日期:2015-01-22) (本文编辑:王利)