中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2012年
11期
922-925
,共4页
罗成伟%翁建宇%吴穗晶%陆泽生%郭荣%杜欣
囉成偉%翁建宇%吳穗晶%陸澤生%郭榮%杜訢
라성위%옹건우%오수정%륙택생%곽영%두흔
移植物抗宿主病%Elafin浓度%ROC曲线
移植物抗宿主病%Elafin濃度%ROC麯線
이식물항숙주병%Elafin농도%ROC곡선
Graft-versus-host disease%Elafin concentration%ROC curve
目的 分析血浆Elafin水平预测皮肤急性移植物抗宿主病(aGVHD)的特异性、敏感性和ROC曲线,探讨其临床诊断价值.方法 前瞻性观察2010年4月至2011年8月在广东省人民医院接受异基因造血干细胞移植资料齐全的53例患者皮肤aGVHD的发病情况,并采用ELISA方法检测血浆中Elafin浓度,出现皮疹患者行组织活检及Elafin免疫组化检测,阳性结果判定为超过50％的表皮层着色.结果 53例移植患者中有28例出现皮疹,临床诊断为皮肤aGVHD 25例,病理活检确诊为皮肤aGVHD 17例,Elafin免疫组化染色阳性11例.Elafin蛋白水平在皮肤aGVHD组织标本中明显过度表达(P =0.001),皮肤aGVHD阳性组患者血浆Elafin浓度明显高于皮肤aGVHD阴性组患者(P =0.005),其中发生Ⅰ度皮肤aGVHD患者血浆Elafin浓度与阴性组患者相比差异无统计学意义(P=0.971),发生Ⅱ～Ⅳ度皮肤aGVHD患者血浆Elafin浓度与Ⅰ度皮肤aGVHD患者及阴性组相比差异有统计学意义(P =0.02;P =0.008).以病理诊断为金标准,临床诊断标准预测皮肤aGVHD的特异性为27.3％、敏感性为100％,组织Elafin蛋白水平预测皮肤aGVHD的特异性为100％、敏感性为64.7％.血浆Elafin水平预测皮肤aGVHD的最佳阈值为1456.043 μg/L,其ROC曲线下面积为0.909(0.797 ～1.021),诊断皮肤aGVHD的敏感性为82.4％,特异性为81.8％.结论 在发生皮肤aGVHD时血浆Elafin水平显著升高,血浆Elafin水平可以作为反映皮肤aGVHD的生物学标志物,具有较好的临床诊断价值.
目的 分析血漿Elafin水平預測皮膚急性移植物抗宿主病(aGVHD)的特異性、敏感性和ROC麯線,探討其臨床診斷價值.方法 前瞻性觀察2010年4月至2011年8月在廣東省人民醫院接受異基因造血榦細胞移植資料齊全的53例患者皮膚aGVHD的髮病情況,併採用ELISA方法檢測血漿中Elafin濃度,齣現皮疹患者行組織活檢及Elafin免疫組化檢測,暘性結果判定為超過50％的錶皮層著色.結果 53例移植患者中有28例齣現皮疹,臨床診斷為皮膚aGVHD 25例,病理活檢確診為皮膚aGVHD 17例,Elafin免疫組化染色暘性11例.Elafin蛋白水平在皮膚aGVHD組織標本中明顯過度錶達(P =0.001),皮膚aGVHD暘性組患者血漿Elafin濃度明顯高于皮膚aGVHD陰性組患者(P =0.005),其中髮生Ⅰ度皮膚aGVHD患者血漿Elafin濃度與陰性組患者相比差異無統計學意義(P=0.971),髮生Ⅱ～Ⅳ度皮膚aGVHD患者血漿Elafin濃度與Ⅰ度皮膚aGVHD患者及陰性組相比差異有統計學意義(P =0.02;P =0.008).以病理診斷為金標準,臨床診斷標準預測皮膚aGVHD的特異性為27.3％、敏感性為100％,組織Elafin蛋白水平預測皮膚aGVHD的特異性為100％、敏感性為64.7％.血漿Elafin水平預測皮膚aGVHD的最佳閾值為1456.043 μg/L,其ROC麯線下麵積為0.909(0.797 ～1.021),診斷皮膚aGVHD的敏感性為82.4％,特異性為81.8％.結論 在髮生皮膚aGVHD時血漿Elafin水平顯著升高,血漿Elafin水平可以作為反映皮膚aGVHD的生物學標誌物,具有較好的臨床診斷價值.
목적 분석혈장Elafin수평예측피부급성이식물항숙주병(aGVHD)적특이성、민감성화ROC곡선,탐토기림상진단개치.방법 전첨성관찰2010년4월지2011년8월재광동성인민의원접수이기인조혈간세포이식자료제전적53례환자피부aGVHD적발병정황,병채용ELISA방법검측혈장중Elafin농도,출현피진환자행조직활검급Elafin면역조화검측,양성결과판정위초과50％적표피층착색.결과 53례이식환자중유28례출현피진,림상진단위피부aGVHD 25례,병리활검학진위피부aGVHD 17례,Elafin면역조화염색양성11례.Elafin단백수평재피부aGVHD조직표본중명현과도표체(P =0.001),피부aGVHD양성조환자혈장Elafin농도명현고우피부aGVHD음성조환자(P =0.005),기중발생Ⅰ도피부aGVHD환자혈장Elafin농도여음성조환자상비차이무통계학의의(P=0.971),발생Ⅱ～Ⅳ도피부aGVHD환자혈장Elafin농도여Ⅰ도피부aGVHD환자급음성조상비차이유통계학의의(P =0.02;P =0.008).이병리진단위금표준,림상진단표준예측피부aGVHD적특이성위27.3％、민감성위100％,조직Elafin단백수평예측피부aGVHD적특이성위100％、민감성위64.7％.혈장Elafin수평예측피부aGVHD적최가역치위1456.043 μg/L,기ROC곡선하면적위0.909(0.797 ～1.021),진단피부aGVHD적민감성위82.4％,특이성위81.8％.결론 재발생피부aGVHD시혈장Elafin수평현저승고,혈장Elafin수평가이작위반영피부aGVHD적생물학표지물,구유교호적림상진단개치.
Objective To analyze the specificity,sensitivity and receiver operating characteristic (ROC) curve of plasma elafin for diagnosis of skin acute graft-versus-host disease (aGVHD),and to explore its clinical diagnostic value.Methods Incidence of skin aGVHD from fifty-three patients received allogeneic hematopoietic stem cell transplantation(allo-HSCT) were observed prospectively in Guangdong General Hospital from Apr 2010 to Aug 2011.The plasma concentrations of elafin were detected by enzyme-linked immunosorbent assay(ELISA).Skin biopsies were taken from 28 patients with skin rash,and elafin expression in the skin was detected by immunohistochemistry.Positive expression was defined as significant staining of at 50％ of the depth of the epidermis,excluding the granular cell layer and the acrosyringium.Results Among 28 patients with skin rash,twenty-five werc considered as skin aGVHD by clinical diagnosis,seventeen were confirmed as skin aGVHD by pathological biospy.11 cases were elafin positive by immunohistochemical staining.Elafin protein was overexpressed in aGVHD skin tissue (P =0.001).Plasma concentrations of elafin were significantly higher in patients with skin aGVHD (positive) group than in those without skin aGVHD (negative) group (P =0.005),among which there being no statistically significant difference in plasma elafin level between patients with grade Ⅰ skin aGVHD group and negative group(P =0.971),but being statistically significant difference compared patients with grade Ⅱ-Ⅳ skin aGVHD group with those with grade Ⅰ skin aGVHD group (P =0.02) and with negative group (P =0.008).Using the pathological diagnosis as the gold standard,the estimated specificity and the sensitivity of clinical diagnosis criteria were 27.3％and 100％,respectively,and thoses of tissue elafin protein level were 100％ and 64.7％,respectively.The area under the ROC curve was 0.909(0.797-1.021) when plasma concentrations of elafin was used in diagnosis of skin aGVHD.The sensitivity was 82.4％ and the specificity was 81.8 ％ when the critical value was set at 1456.043 μg/L.Conclusion Plasma concentration of elafin is significantly higher at the onset of skin aGVHD.It can be used as biochemical marker of skin aGVHD and has higher value in diagnosis of skin aGVHD.
