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  本文選題：ARDS　切入點：肝素結合蛋白　出處：《浙江大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:采用酶聯(lián)免疫吸附法檢測肝素結合蛋白在急性呼吸窘迫綜合征(ARDS)患者血液(血漿)中的表達水平,探討定量檢測肝素結合蛋白在臨床中的診斷ARDS的應用價值,比較非ARDS患者、ARDS患者及嚴重ARDS患者血液中肝素結合蛋白與降鈣素原、超敏C反應蛋白和IL-17在ARDS中的診斷意義。方法:采集20例健康志愿者,35例非ARDS患者,35例ARDS患者,35例嚴重ARDS患者的全血,采用酶聯(lián)免疫吸附法(ELISA)對各實驗組血漿進行肝素結合蛋白(heparin-bindingprotein,HBP)的定量測定,同時還結合了酶聯(lián)熒光法檢測血漿中的降鈣素原(procalcitonin,PCT)水平、采用比濁法檢測其中的超敏C反應蛋白(hs-CRP)水平,酶聯(lián)免疫吸附法(ELISA)檢測IL-17;將實驗組和對照組血漿中各指標的檢測結果進行統(tǒng)計、比較;繪制受試者操作特征曲線(receiver operating characteristic curve,ROC 曲線),并對曲線下的面積(area under the curve,AUC)進行計算,找出最佳的截斷值,通過該值分析并比較HBP、PCT、hs-CRP和IL-17等在診斷ARDS時的靈敏度和特異度。結果:健康對照組、非ARDS組、ARDS組、嚴重ARDS組HBP各組間差異均有統(tǒng)計學意義(P0.01);ARDS組和嚴重ARDS組、健康對照組和非ARDS組間差別均有統(tǒng)計學意義(P0.01),嚴重ARDS組高于ARDS組,且組間差異有統(tǒng)計學意義(P0.05),非ARDS組與ARDS組差別無統(tǒng)計學意義(P=0.32);PCT水平各組間差異均有統(tǒng)計學意義(P0.01);hs-CRP各組間差異均有統(tǒng)計學意義(P0.01);IL-17各組間差異均有統(tǒng)計學意義(P0.01)。經(jīng)ROC曲線分析顯示HBP曲線下面積為0.772,且血漿中HBP濃度為11.5ng/m1時,其診斷ARDS的敏感度能達到76.1%,特異度高達78.8%。當HBP濃度達到19.6ng/m1時,其診斷嚴重ARDS的靈敏度為85.1%,特異度為89.8%。結論:血漿中HBP、PCT、hs-CRP和IL-17在臨床上都可以作為ARDS的檢測指標,且可以根據(jù)值的大小對患者病情進行評估。當HBP濃度達到30ng/m1時,其診斷嚴重ARDS的靈敏度和特異度分別為為85.1%和89.8%,可以作為ARDS良好的預警標志物,對于ARDS病情進展的監(jiān)測作用很大。如果和患者血漿中的HBP,PCT和IL-17聯(lián)合檢測,對ARDS的預測效果更好。
[Abstract]:Objective: to detect the expression of heparin binding protein (heparin binding protein) in blood (plasma) of patients with acute respiratory distress syndrome (ARDS) by enzyme linked immunosorbent assay (Elisa), and to explore the value of quantitative detection of heparin binding protein in clinical diagnosis of ARDS. The levels of heparin binding protein and procalcitonin in the blood of non-ARDS patients and severe ARDS patients were compared. Diagnostic significance of hypersensitive C-reactive protein and IL-17 in ARDS methods: the whole blood samples of 35 patients with ARDS, 35 patients with ARDS and 35 patients with severe ARDS were collected from 20 healthy volunteers. The plasma heparin-binding protein (HBP) and procalcitonin (PCT) levels in plasma of each experimental group were determined by enzyme-linked immunosorbent assay (Elisa) and enzyme-linked fluorescence assay (Elisa). The levels of hypersensitive C-reactive protein hs-CRP and IL-17 were detected by turbidimetry and Elisa respectively. The receiver operating characteristic curve was drawn and the area area under the curveted under the curve was calculated to find the best truncation value. The sensitivity and specificity of IL-17 and hs-CRP in the diagnosis of ARDS were analyzed and compared. Results: there were significant differences between the healthy control group, the non-ARDS group, the severe ARDS group and the severe ARDS group in the diagnosis of ARDS. The difference between healthy control group and non ARDS group was statistically significant (P 0.01), and that in severe ARDS group was higher than that in ARDS group. There was no significant difference between ARDS group and ARDS group. There was significant difference in P0.01hs-CRP level among all groups. There was significant difference in P0.01hs-CRP level among all groups. There was a significant difference in P0.01IL-17 level among all groups. There was significant difference in P0.01hs-CRP level between all groups. There was a significant difference in P0.01hs-CRP level between all groups. There was significant difference in P0.01hs-CRP level between all groups. There was a significant difference in P0.01hs-CRP level between the two groups. The curve analysis showed that the area under the HBP curve was 0.772and the plasma HBP concentration was 11.5 ng / m ~ (-1). When the concentration of HBP reached 19.6 ng / ml, the sensitivity and specificity of HBP in the diagnosis of severe ARDS were 85.1 and 89.80.Conclusion: Hs-CRP and IL-17 in plasma can be used as a clinical index for the detection of ARDS, and its sensitivity is 76.1% and specificity is 78.80.When the concentration of HBP reaches 19.6ng / ml, the sensitivity is 85.1 and the specificity is 89.80.Conclusion: HBPT-hs-CRP and IL-17 in plasma can be used as indicators for the detection of ARDS. The sensitivity and specificity of HBP in the diagnosis of severe ARDS were 85.1% and 89.8, respectively, which could be used as a good early warning marker for ARDS. It can be used to monitor the progression of ARDS. If combined with HBPP-PCT and IL-17 in the plasma of patients, the prediction effect of ARDS is better.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.8

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本文編號：1591435