CAJ | 학술논문

为了探讨血浆凝血酶调节蛋白(PTM)检测的临床价值,用ELISA法测定979例患者的PTM,并选择60名健康人作为对照.结果表明:对照组PTM水平为20.40±7.72 μg/L,无性别和年龄差异.在疾病组中,原发性慢性肾小球疾病肾功能衰竭(CRF)组PTM水平高于无CRF组,败血症组PTM水平高于非败血症组,多脏器功能衰竭(MOF)组PTM水平高于无MOF组(P＜0.01);以＞70、＞50和＞40 μg/L为标准,分别预示CRF、败血症和MOF的灵敏度为85.7%、86.6%和77.8%,特异性为82.4%、89.5%和77.3%,阳性预示值为77.8%、76.5%和73.7%.系统性红斑狼疮(SLE)尿蛋白阳性组PTM水平高于阴性组;糖尿病并发症组的PTM水平高于无并发症组,并发微血管病变组的PTM水平高于大血管病变组(P均＜0.01);以PTM高于正常上限值(＞35.54 μg/L)为标准,预示SLE尿蛋白阳性临床肾损害、糖尿病并发症和微血管病变的灵敏度为77.8%、53.4%和71.2%,特异性为92.3%、97.1%和97.1%,阳性预示值为93.3%、98.6%和97.9%.急性白血病(AL)和多发性骨髓瘤(MM)初诊时PTM升高,两病并发肾衰时极度升高(P＜0.01).动态检测多发伤、脑卒中急性期和恢复期、AL和MM化疗前后、癌症术前后PTM水平与病情变化相关.以微血管病变为主要疾病的PTM水平高于大血管病变疾病(P＜0.01),以高于正常上限值为标准,微血管病变疾病的灵敏度为77.7%、特异性71.2%,阳性预示值75.6%.结论:PTM水平是评估微血管病变疾病的良好指标,也是预警或评估疾病严重程度及其演变或疗效观察的有用指标.
위료탐토혈장응혈매조절단백(PTM)검측적림상개치,용ELISA법측정979례환자적PTM,병선택60명건강인작위대조.결과표명:대조조PTM수평위20.40±7.72 μg/L,무성별화년령차이.재질병조중,원발성만성신소구질병신공능쇠갈(CRF)조PTM수평고우무CRF조,패혈증조PTM수평고우비패혈증조,다장기공능쇠갈(MOF)조PTM수평고우무MOF조(P＜0.01);이＞70、＞50화＞40 μg/L위표준,분별예시CRF、패혈증화MOF적령민도위85.7%、86.6%화77.8%,특이성위82.4%、89.5%화77.3%,양성예시치위77.8%、76.5%화73.7%.계통성홍반랑창(SLE)뇨단백양성조PTM수평고우음성조;당뇨병병발증조적PTM수평고우무병발증조,병발미혈관병변조적PTM수평고우대혈관병변조(P균＜0.01);이PTM고우정상상한치(＞35.54 μg/L)위표준,예시SLE뇨단백양성림상신손해、당뇨병병발증화미혈관병변적령민도위77.8%、53.4%화71.2%,특이성위92.3%、97.1%화97.1%,양성예시치위93.3%、98.6%화97.9%.급성백혈병(AL)화다발성골수류(MM)초진시PTM승고,량병병발신쇠시겁도승고(P＜0.01).동태검측다발상、뇌졸중급성기화회복기、AL화MM화료전후、암증술전후PTM수평여병정변화상관.이미혈관병변위주요질병적PTM수평고우대혈관병변질병(P＜0.01),이고우정상상한치위표준,미혈관병변질병적령민도위77.7%、특이성71.2%,양성예시치75.6%.결론:PTM수평시평고미혈관병변질병적량호지표,야시예경혹평고질병엄중정도급기연변혹료효관찰적유용지표.
The purpose of this study was to investigate the clinical value of plasma thrombomodulin (PTM) in different diseases or in different severity or complications of diseases, PTM in 979 patients and 60 healthy controls was determined by ELISA method. The results showed that the PTM level in the control group was 20.40 ± 7.72 μg/L, there was no difference in sex and ages. In chronic primary glomerular disease, the PTM level in chronic renal failure (CRF)group was higher than that in non-CRF group (P ＜ 0.01 ). PTM level ＞ 70 μg/L was defined as its positive criterion.The sensitivity, specificity and positive predictive value in PTM were 85.7%, 82.4% and 77.8% respectively. The PTM level in septemia group was higher than that in non-septemia group ( P ＜ 0.01 ), the sensitivity, specificity and positive predictive value were 86.6%, 89.5% and 76.5% respectively ( ＞ 50 μg/L as its positive criterion). With respect of multiple trauma, the PTM level in multiple organ failare (MOF) group was higher than that in non-MOF group ( P ＜0.01 ), while the sensitivity, specificity and positive predictive value were 77.8%, 77.3% and 73.7% respectively ( ＞40 μg/L as its positive criterion). For systemic lupus erythematosus (SLE), the PTM level in the patients with albuminuria was higher than that in the patients without albuminuria (P ＜ 0.01 ), and the sensitivity, specificity and positive predictive value were 77.8%, 92.3% and 93.3% respectively ( ＞ 35.54 μg/L as its positive criterion). For diabetes, the PTM level in complication group was higher than that in group without complications, the sensitivity, specificity and positive predictive value were 53.4% ,97.1% and 98.6% respectively ( ＞ 35.54 μg/L as its positive criterion).The PTM level in microangiopathy group was higher than that in macroangiopathy group (P ＜ 0.01 ). The sensitivity,specificity and positive predictive value were 71.2%, 97.1% and 97.9% respectively. Acute leukemia (AL) and multiple myeloma (MM) had higher PTM level and PTM level was extremely high when renal failure developed ( P ＜ 0.01 ). As compared the acute stage with the restoration stage in stroke, pre-chemotherapeutics with post-chemotherapeutics in AL and MM, and pre-operation with post-operation in cancer, the PTM level was connected with clinical development. The PTM level in the patients with microangiopathy was higher than that in the patients with macroangiopathy (P＜ 0.01 ). The defined PTM level was higher than its normal upper limit as PTM positive criterion in microangiopathy diseases, the sensitivity, specificity and positive predictive value were 77.7%, 71.2% and 75.6% respectively. It is concluded that PTM level is a good criterion in evaluating the microangiopathy, and PTM is also a valuable indicator in prediction or assessment of the severity of diseases, or evaluation of therapeutic effectiveness.