2020 年第 12 期 第 15 卷

血清肌腱蛋白C和骨膜蛋白水平对重度支气管哮喘的诊断价值

Diagnostic value of serum tendon protein C and periosteum protein levels in patients with severe bronchial asthma

作者：郑亚妹1蔡兴俊1符宗军2

英文作者：Zheng Yamei1 Cai Xingjun1 Fu Zongjun2

单位：1海南省人民医院呼吸与危重症医学科，海口570311；2海南省人民医院神经内科神经电生理室，海口570311

英文单位：1Department of Respiratory and Critical Care Medicine Hainan General Hospital Haikou 570311 China; 2Department of Neurology Neuroelectrophysiology Room Hainan General Hospital Haikou 570311 China

关键词：重度支气管哮喘；肌腱蛋白C；骨膜蛋白

英文关键词：Severebronchialasthma；TenascinC；Periosteumprotein

• 摘要：

• 目的 探讨血清肌腱蛋白C、骨膜蛋白水平对重度支气管哮喘的诊断价值。方法 选择2016年2月至2019年10月海南省人民医院收治的重度支气管哮喘患者89例（重度组），另选择120例同期收治的轻中度支气管哮喘患者（轻中度组）和50名门诊体检健康的志愿者（对照组），均进行血清肌腱蛋白C和骨膜蛋白检测。分析重度支气管哮喘患者肌腱蛋白C、骨膜蛋白水平与肺功能和白细胞介素4（IL-4）、外周血嗜酸粒细胞计数（EOS）、免疫球蛋白E（IgE）、呼出气一氧化氮（FeNO）水平相关性。绘制受试者工作特征曲线分析肌腱蛋白C、骨膜蛋白、肌腱蛋白C+骨膜蛋白诊断重度支气管哮喘的价值。结果 重度组血清肌腱蛋白C、骨膜蛋白、IL-4、EOS、IgE、FeNO水平高于轻中度组和对照组，轻中度组血清肌腱蛋白C、骨膜蛋白、IL-4、EOS、IgE、FeNO水平高于对照组（均P＜0.05）。重度组患者第1秒用力呼气容积与用力肺活量比值（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1%pred）低于轻中度组和对照组，轻中度组FEV1/FVC、FEV1%pred低于对照组（均P＜0.05）。重度支气管哮喘患者肌腱蛋白C、骨膜蛋白水平与FEV1/FVC、FEV1%pred均呈负相关，与EOS、IgE、FeNO、IL-4水平均呈正相关（均P＜0.05）。受试者工作特征曲线分析结果显示，肌腱蛋白C、骨膜蛋白诊断重度支气管哮喘的曲线下面积分别为0.709（95%置信区间：0.640～0.779，P＜0.001）、0.748（95%置信区间：0.680～0.817，P＜0.001），而肌腱蛋白C+骨膜蛋白诊断重度支气管哮喘的曲线下面积为0.894（95%置信区间：0.849～0.940，P＜0.001），明显高于肌腱蛋白C、骨膜蛋白单独诊断（Z=3.021、2.654，均P＜0.05）。结论 血清肌腱蛋白C、骨膜蛋白水平与支气管哮喘病情严重程度有关，可用于重度支气管哮喘的辅助诊断，二者联合检测可提高诊断效能。

• Objective To investigate the diagnostic value of serum tenascin C （TNC）and periosteum protein（POSTN） in patients with severe bronchial asthma. Methods From February 2016 to October 2019, 89 patients with severe bronchial asthma treated in Hainan General Hospital were selected as severe group. Another 120 patients with mild to moderate bronchial asthma treated in the same period were selected as mild to moderate group and 50 healthy volunteers were selected as control group. Serum TNC and periosteal protein were detected in all subjects. The correlation of TNC and POSTN levels with lung function, interleukin-4 (IL-4), eosinophil count (EOS), immunoglobulin E (IgE) and fractional exhaled nitric oxide (FeNO) levels in patients with severe bronchial asthma were analyzed. The value of TNC, POSTN and TNC+POSTN in the diagnosis of severe bronchial asthma was analyzed by drawing the subject work characteristic curve（ROC）.Results The levels of TNC, POSTN, IL-4, EOS, IgE and FeNO in the severe group were higher than those in the mild to moderate group and the control group, and the levels of serum TNC, POSTN, IL-4, EOS, IgE and FeNO in the mild to moderate group were higher than those in the control group (all P＜0.05). The ratio of forced expiratory volume at the 1st second to forced vital capacity (FEV1/FVC) and the percentage of forced expiratory volume at the 1st second (FEV1%pred) in the severe group were lower than those in mild to moderate group and control group， FEV1/FVC and FEV1% pred in the mild to moderate group were lower than those in the control group (all P＜0.05). The results of correlation analysis showed that TNC and POSTN were negatively correlated with FEV1/FVC and FEV1%pred, and positively correlated with EOS, IgE, FeNO and IL-4 (all P＜0.05) in severe asthma patients. ROC analysis showed that area under curve (AUC) of TNC, POSTN and TNC+POSTN were 0.709 (95% confidence interval: 0.640-0.779), 0.748(95% confidence interval: 0.680-0.817) and 0.894(95% confidence interval: 0.849-0.940), respectively. The AUC of TNC+POSTN was higher than that of TNC and POSTN (Z=3.021, 2.654, both P＜0.05). Conclusion sTNC and POSTN are related to the severity of bronchial asthma. They can be used for the auxiliary diagnosis of severe bronchial asthma. Combined with TNC and POSTN can increase the diagnostic efficiency.