目的 研究社区获得性肺炎(CAP)患者甘露聚糖结合凝集素(MBL)结构基因第一外显子54位密码子基因多态性及血清MBL、C-反应蛋白(CRP)水平对疾病严重程度的评估价值.方法 采用前瞻性观察性临床研究方法,选择天津市人民医院住院的汉族成人CAP患者104例,检测MBL 54位密码子点突变频率;进行肺炎严重指数(PSI)评分并分级;于治疗前及治疗4d、7d采用酶联免疫吸附试验(ELISA)检测血清MBL水平,用免疫比浊法检测CRP水平.另外选取100例同地区年龄、性别、民族匹配的健康体检人群作为对照组.比较CAP组与对照组及不同PSI分级CAP患者血清MBL、CRP水平,并进行相关性分析.结果 CAP组与对照组MBL 54位密码子存在GGC→GAC变异,两组MBL 54位密码子野生型及杂合突变型基因型频率(x2=0.018,P=0.893)和等位基因频率(x2=0.019,P=0.903)的分布无统计学差异.CAP组治疗前及治疗4d、7d血清MBL水平(mg/L)先升后降,分别为3.75±1.78、4.53±1.99、4.04±1.91,均明显高于对照组(2.84±1.41,均P＜0.01);血清CRP水平(mg/L)逐渐下降,分别为66.88±40.47、51.21±37.54、36.91±36.02,均明显高于对照组(6.96±2.19,均P＜0.01).CAP患者PSI分级Ⅰ级12例,Ⅱ级32例,Ⅲ级20例,Ⅳ级22例,V级18例.不同PSI分级之间(x2=1.210,P=0.876)、普通病房与重症监护病房之间(x2=0.569,P=0.451) MBL 54位密码子基因型分布无统计学意义.CAP患者不同PSI分级之间血清MBL水平在治疗前(F=1.313,P=0.279)、治疗4d(F=1.705,P=0.165)、治疗7 d(F=1.684,P=0.170)差异均无统计学意义;PSIⅡ～V级患者治疗4d时血清MBL浓度较治疗前均明显增高,治疗7d时降至治疗前水平.CAP患者不同PSI分级之间血清CRP水平在治疗前(F=23.179,P=0.000)、治疗4d(F=26.601,P=0.000)、治疗7 d(F=10.358,P=0.000)差异均有统计学意义;PSI各级患者血清CRP水平均随治疗时间逐渐下降,PSI分级越高,血清CRP下降越不明显.CAP患者治疗前及治疗4d、7d时PSI分级与血清MBL均无相关性(治疗前r=-0.205,P=0.145;治疗4 dr=-0.062,P=0.662;治疗7 d r=-0.063,P=0.656),与血清CRP均呈显著正相关(治疗前r=0.809,P=0.000;治疗4dr=0.842,P=0.000;治疗7 d r=0.702,P=0.000).结论 MBL 54位密码子基因型对CAP疾病严重程度无影响;CAP患者血清MBL升高并随治疗时间呈动态变化,可作为CAP的炎性标志物,但尚不能用于对CAP疾病严重程度的评估.
目的 研究社區穫得性肺炎(CAP)患者甘露聚糖結閤凝集素(MBL)結構基因第一外顯子54位密碼子基因多態性及血清MBL、C-反應蛋白(CRP)水平對疾病嚴重程度的評估價值.方法 採用前瞻性觀察性臨床研究方法,選擇天津市人民醫院住院的漢族成人CAP患者104例,檢測MBL 54位密碼子點突變頻率;進行肺炎嚴重指數(PSI)評分併分級;于治療前及治療4d、7d採用酶聯免疫吸附試驗(ELISA)檢測血清MBL水平,用免疫比濁法檢測CRP水平.另外選取100例同地區年齡、性彆、民族匹配的健康體檢人群作為對照組.比較CAP組與對照組及不同PSI分級CAP患者血清MBL、CRP水平,併進行相關性分析.結果 CAP組與對照組MBL 54位密碼子存在GGC→GAC變異,兩組MBL 54位密碼子野生型及雜閤突變型基因型頻率(x2=0.018,P=0.893)和等位基因頻率(x2=0.019,P=0.903)的分佈無統計學差異.CAP組治療前及治療4d、7d血清MBL水平(mg/L)先升後降,分彆為3.75±1.78、4.53±1.99、4.04±1.91,均明顯高于對照組(2.84±1.41,均P＜0.01);血清CRP水平(mg/L)逐漸下降,分彆為66.88±40.47、51.21±37.54、36.91±36.02,均明顯高于對照組(6.96±2.19,均P＜0.01).CAP患者PSI分級Ⅰ級12例,Ⅱ級32例,Ⅲ級20例,Ⅳ級22例,V級18例.不同PSI分級之間(x2=1.210,P=0.876)、普通病房與重癥鑑護病房之間(x2=0.569,P=0.451) MBL 54位密碼子基因型分佈無統計學意義.CAP患者不同PSI分級之間血清MBL水平在治療前(F=1.313,P=0.279)、治療4d(F=1.705,P=0.165)、治療7 d(F=1.684,P=0.170)差異均無統計學意義;PSIⅡ～V級患者治療4d時血清MBL濃度較治療前均明顯增高,治療7d時降至治療前水平.CAP患者不同PSI分級之間血清CRP水平在治療前(F=23.179,P=0.000)、治療4d(F=26.601,P=0.000)、治療7 d(F=10.358,P=0.000)差異均有統計學意義;PSI各級患者血清CRP水平均隨治療時間逐漸下降,PSI分級越高,血清CRP下降越不明顯.CAP患者治療前及治療4d、7d時PSI分級與血清MBL均無相關性(治療前r=-0.205,P=0.145;治療4 dr=-0.062,P=0.662;治療7 d r=-0.063,P=0.656),與血清CRP均呈顯著正相關(治療前r=0.809,P=0.000;治療4dr=0.842,P=0.000;治療7 d r=0.702,P=0.000).結論 MBL 54位密碼子基因型對CAP疾病嚴重程度無影響;CAP患者血清MBL升高併隨治療時間呈動態變化,可作為CAP的炎性標誌物,但尚不能用于對CAP疾病嚴重程度的評估.
목적 연구사구획득성폐염(CAP)환자감로취당결합응집소(MBL)결구기인제일외현자54위밀마자기인다태성급혈청MBL、C-반응단백(CRP)수평대질병엄중정도적평고개치.방법 채용전첨성관찰성림상연구방법,선택천진시인민의원주원적한족성인CAP환자104례,검측MBL 54위밀마자점돌변빈솔;진행폐염엄중지수(PSI)평분병분급;우치료전급치료4d、7d채용매련면역흡부시험(ELISA)검측혈청MBL수평,용면역비탁법검측CRP수평.령외선취100례동지구년령、성별、민족필배적건강체검인군작위대조조.비교CAP조여대조조급불동PSI분급CAP환자혈청MBL、CRP수평,병진행상관성분석.결과 CAP조여대조조MBL 54위밀마자존재GGC→GAC변이,량조MBL 54위밀마자야생형급잡합돌변형기인형빈솔(x2=0.018,P=0.893)화등위기인빈솔(x2=0.019,P=0.903)적분포무통계학차이.CAP조치료전급치료4d、7d혈청MBL수평(mg/L)선승후강,분별위3.75±1.78、4.53±1.99、4.04±1.91,균명현고우대조조(2.84±1.41,균P＜0.01);혈청CRP수평(mg/L)축점하강,분별위66.88±40.47、51.21±37.54、36.91±36.02,균명현고우대조조(6.96±2.19,균P＜0.01).CAP환자PSI분급Ⅰ급12례,Ⅱ급32례,Ⅲ급20례,Ⅳ급22례,V급18례.불동PSI분급지간(x2=1.210,P=0.876)、보통병방여중증감호병방지간(x2=0.569,P=0.451) MBL 54위밀마자기인형분포무통계학의의.CAP환자불동PSI분급지간혈청MBL수평재치료전(F=1.313,P=0.279)、치료4d(F=1.705,P=0.165)、치료7 d(F=1.684,P=0.170)차이균무통계학의의;PSIⅡ～V급환자치료4d시혈청MBL농도교치료전균명현증고,치료7d시강지치료전수평.CAP환자불동PSI분급지간혈청CRP수평재치료전(F=23.179,P=0.000)、치료4d(F=26.601,P=0.000)、치료7 d(F=10.358,P=0.000)차이균유통계학의의;PSI각급환자혈청CRP수평균수치료시간축점하강,PSI분급월고,혈청CRP하강월불명현.CAP환자치료전급치료4d、7d시PSI분급여혈청MBL균무상관성(치료전r=-0.205,P=0.145;치료4 dr=-0.062,P=0.662;치료7 d r=-0.063,P=0.656),여혈청CRP균정현저정상관(치료전r=0.809,P=0.000;치료4dr=0.842,P=0.000;치료7 d r=0.702,P=0.000).결론 MBL 54위밀마자기인형대CAP질병엄중정도무영향;CAP환자혈청MBL승고병수치료시간정동태변화,가작위CAP적염성표지물,단상불능용우대CAP질병엄중정도적평고.
Objective To evaluate the significance of the mannose-binding lection (MBL) gene polymorphism at code 54 of exon 1 and MBL serum level and C-reactive protein (CRP) in the severity of community acquired pneumonia (CAP) in adults.Methods A prospective observation was conducted.104 adults Han patients with CAP hospitalized in Tianjin People's Hospital were enrolled.Frequencies of MBL54 alleles and genotypes were measured.The patients were evaluated by pneumonia severity index (PSI) score and were graded.Serum MBL was determined by enzyme linked immunosorbent assay (ELISA),and serum CRP was detected by immunoturbidimetry before and 4 days and 7 days after the treatment.100 healthy control subjects with the same region,age,gender,nationality were enrolled as control group.Serum MBL and CRP levels were compared between CAP group and the control group or among different grades of PSI,and the correlation was analyzed.Results The variation of GGC→GGC in MBL54 was found in CAP patients and controls.Similar frequencies of genotypes (x2=0.018,P=0.893) and alleles (x2=0.019,P=0.903) of MBL54 with wild type and mutant type were found between two groups.The serum MBL level (mg/L) before and 4 days and 7 days after the treatment in CAP group was increased followed by the reduction and they were 3.75 ± 1.78,4.53 ± 1.99 and 4.04 ± 1.91,respectivelv,which were significantly higher than those in control group (2.84 ± 1.41,all P＜0.01).The serum CRP levels (mg/L) in CAP group were gradually declined,and they were 66.88 ± 40.47,51.21 ± 37.54,36.91 ± 36.02,respectively,which were significantly higher than those in control group (6.96 ± 2.19,all P＜0.01).There were 12 cases with PSI grade Ⅰ,32 cases with grade Ⅱ,20 cases with grade Ⅲ,22 cases with grade Ⅳ and 18 cases with grade V in CAP patients.There was no significant difference in frequencies of MBL54 genotypes among different grades of PSI (x2=1.210,P=0.876) and between general ward and intensive care unit (x2=0.569,P=0.451).No differences in the serum MBL level before (F=1.313,P=0.279) and 4 days (F=1.705,P=0.165) and 7 days (F=1.684,P=0.170) after the treatment were found among different PSI grades.The serum MBL level 4 days after the treatment was significantly higher than that before treatment,then decreased to the level before treatment on the 7th day after treatment in CAP patients with grade Ⅱ-Ⅳ.There was significant difference in serum CRP level before (F=23.179,P=0.000) and 4 days (F=26.601,P=0.000) and 7 days (F=10.358,P=0.000) after the treatment among different PSI grades in CAP patients.The serum levels of CRP in patients with different PSI grades were gradually decreased with time prolonged,the higher the PSI grade,the more obscure the serum CRP decrease.No correlation was found between PSI grade and serum MBL before and 4 days and 7 days after the treatment (before treatment:r=-0.205,P=0.145; 4 days after treatment:r=-0.062,P=0.662; 7 days after treatment:r=-0.063,P=0.656),and positive correlation between PSI grade and serum CRP was found (before treatment:r=0.809,P=0.000; 4 days after treatment:r=0.842,P=0.000; 7 days after treatment:r=0.702,P=0.000).Conclusions The MBL54 codon genotypes had no effect on the susceptibility of CAP.The serum MBL was elevated and dynamic changes with increasing treatment time in CAP patients were shown.MBL can be used as a reaction of CAP in acute stage.But it cannot be used as an inflammatory marker for the severity of CAP.
