摘要
目的 观察支气管哮喘发作期不同严重程度哮喘患者血中1-磷酸鞘氨醇（S1P）水平的变化,探讨S1P对哮喘患者病情严重程度的评估价值.方法 采用前瞻性观察性研究方法,选择2015年11月至2017年1月于佳木斯大学附属第一医院呼吸内科门诊及住院的52例哮喘发作期患者,按照疾病严重程度分为轻、中、重度3组;以本院同期25例健康体检者作为健康对照组.取所有受试者清晨空腹外周静脉血,采用酶联免疫吸附试验（ELISA）检测血中S1P水平,采用全血细胞自动分析仪检测血中嗜酸粒细胞计数（EOS）,同时进行肺功能检查;各观察指标之间的相关性采用Pearson相关分析;绘制受试者工作特征曲线（ROC）,分析血中S1P对哮喘严重程度的评估价值.结果 52例哮喘患者均纳入最终分析,其中轻度17例、中度19例、重度16例.与健康对照组比较,不同程度哮喘各组血中S1P和EOS水平明显升高,1 s用力呼气容积（FEV1）明显降低;且随哮喘病情加重,血中S1P和EOS水平均逐渐升高〔轻、中、重度S1P（nmol/L）分别为1537.0±120.3、1980.7±149.5、2202.2±117.2（F=274.624,P=0.001）,EOS（×109/L）分别为0.13±0.06、0.20±0.07、0.37±0.14（F=44.093,P=0.001）〕,FEV1逐渐降低〔轻、中、重度分别为0.89±0.05、0.69±0.06、0.42±0.10（F=159.756,P=0.001）〕.相关性分析显示,轻、中、重度哮喘患者血中S1P与EOS水平均呈显著正相关（r值分别为0.696、0.746、0.508,均P〈0.05）,与FEV1均呈显著负相关（r值分别为-0.761、-0.655、-0.815,均P〈0.01）;而健康对照者血中S1P与EOS水平和FEV1均无明显相关性（r值分别为0.324、-0.048,均P〉0.05）.ROC曲线分析显示,血中S1P水平评估轻、中、重度哮喘的ROC曲线下面积（AUC）分别为0.948,1.000、1.000;当截断值为1181.8、1534.2、1708.6 nmol/L时,敏感度分别为88.2%、100%、100%,特异度分别为88.0%、100%、100%.结论 哮喘发作期患者血中S1P水平随病情加重而逐渐升高,其对哮喘严重程度具有较高的评估价值.
Objective To observe the changes of serum sphingosine-1-phosphate （S1P） level in asthmatic patients with different severity of bronchial asthma, and to explore the evaluation value of S1P on the severity of asthma.Methods A prospective observational study was conducted. Fifty-two patients with asthma admitted to Department of Respiratory Medicine of the First Affiliated Hospital of Jiamusi University from November 2015 to January 2017 were enrolled. According to the severity of the disease, the patients were divided into mild, moderate and severe groups. In the same period, 25 healthy subjects were served as healthy control group. All the subjects got the peripheral venous blood collection in the morning fasting, the level of serum S1P was determined by enzyme linked immunosorbent assay （ELISA）, the peripheral blood eosinophil （EOS） was counted, and the pulmonary function test was performed. The correlation among the parameters was analyzed by Pearson correlation analysis. Receiver operating characteristic curve （ROC） was plotted, and the value of serum S1P on evaluating the severity of asthma was analyzed.Results Fifty-two asthma patients were enrolled, including 17 patients of the mild, 19 of the moderate, and 16 of the severe. Compared with the healthy control group, serum S1P level and peripheral blood EOS in different degree asthma groups were significantly increased, and forced expiratory volume in 1 second （FEV1） was decreased significantly; and with asthma exacerbations, serum S1P levels and peripheral blood EOS were gradually increased [mild, moderate and severe S1P （nmol/L） were 1537.0±120.3, 1980.7±149.5, 2202.2±117.2 （F= 274.624, P= 0.001）; EOS （×109/L） were 0.13±0.06, 0.20±0.07, 0.37±0.14 , respectively （F= 44.093,P = 0.001）], and FEV1 was decreased gradually [mild, moderate and severe were 0.89±0.05, 0.63±0.06, 0.42±0.10, respectively （F= 159.756,P = 0.001）]. Correlation analysis showed that there were significant positive correlations between serum S1P level and peripheral blood EOS in patients with mild, moderate and severe asthma （r value was 0.696, 0.746,0.508, allP 〈 0.05）, and negatively correlations with FEV1 were found （r value was -0.761, -0.655, -0.815, all P 〈 0.01）. There was no significant correlation between serum S1P level and EOS, FEV1 in healthy control group （r value was 0.324 and -0.048, bothP〉 0.05）. ROC curve analysis showed that the area under curve （AUC） of serum S1P for assessing mild, moderate and severe asthma was 0.948, 1.000, 1.000, respectively; when the cut-off of S1P was 1181.8, 1534.2, 1708.6 nmol/L, the sensitivity was 88.2%, 100%, 100%, and the specificity was 88.0%, 100% and 100%, respectively.Conclusions During asthma attack, the serum S1P level was gradually increased with the exacerbation of the disease. Serum S1P level has significant evaluative effect on the severity of asthma.
作者
赵蕴伟
徐意芹
李爽
魏煜
王春玲
Zhao Yunwei Xu Yiqin Li Shuang Wei Yu Wang Chunling(Department of Respiration, the First Affiliated Hospital of Jiamusi University, Jiamusi 154002, Heilongjiang, China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第9期794-798,共5页
Chinese Critical Care Medicine
基金
黑龙江省卫生计生委科研项目（2016-299）
