鞘氨醇-1-磷酸和 CRP 作为潜在的联合生物标志物在鉴别 COPD 合并社区获得性肺炎和 COPD 急性加重中的作用。
Sphingosine-1-phosphate and CRP as potential combination biomarkers in discrimination of COPD with community-acquired pneumonia and acute exacerbation of COPD.
机构信息
Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
出版信息
Respir Res. 2022 Mar 20;23(1):63. doi: 10.1186/s12931-022-01991-1.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a significant public health concern. The patients with acute exacerbations of COPD (AECOPD) and pneumonia have similar clinical presentations. The use of conventional diagnostic markers, such as complete blood count with differential and C-reactive protein (CRP), is the current mainstream method for differentiating clinically relevant pneumonia from other mimics. However, those conventional methods have suboptimal sensitivity and specificity for patients with a clinical suspicion of infection. The limitations often cause the ambiguity of the initiation of antibiotic treatment. Recently, our pilot study suggested that the patients with pneumonia have significantly higher plasma Sphingosine-1-phosphate (S1P) levels than controls. The initial findings suggest that plasma S1P is a potential biomarker for predicting prognosis in pneumonia. The aim of this study was to evaluate the value of S1P and CRP for discriminating COPD with pneumonia and AECOPD in an Emergency Department (ED) setting.
METHODS
Patients diagnosed with AECOPD or COPD with pneumonia were recruited from the Emergency Department of Wan Fang Hospital. The clinical data, demographics, and blood samples were collected upon ED admission. The concentration of plasma S1P was measured by ELISA.
RESULTS
Thirty-nine patients with AECOPD and 78 with COPD plus pneumonia were enrolled in this observational study. The levels of blood S1P and CRP were significantly higher in patients with COPD plus CAP compared to those in AE COPD patients. The area under the receiver operator characteristic (ROC) curve for the S1P and CRP for distinguishing between patients with COPD plus CAP and AECOPD is 0.939 (95% CI: 0.894-0.984) and 0.886 (95% CI: 0.826-0.945), whereas the combination of S1P and CRP yielded a value of 0.994 (95% CI: 0.897-1.000). By comparing with CRP or S1P, combining CRP and S1P had significantly higher AUC value for differentiating between the COPD with pneumonia group and the AECOPD group.
CONCLUSIONS
Our findings suggest that S1P is a potential diagnostic biomarker in distinguishing COPD with CAP from AECOPD. Additionally, the diagnostic ability of S1P can be improved when used in combination with CRP.
背景
慢性阻塞性肺疾病（COPD）是一个重大的公共卫生问题。COPD 急性加重（AECOPD）和肺炎患者的临床表现相似。目前，区分临床相关肺炎与其他类似疾病的主流方法是使用全血细胞计数和分类以及 C 反应蛋白（CRP）等常规诊断标志物。然而，这些常规方法对临床疑似感染患者的敏感性和特异性较低。这些局限性常常导致抗生素治疗的启动存在模糊性。最近，我们的初步研究表明，肺炎患者的血浆鞘氨醇-1-磷酸（S1P）水平明显高于对照组。初步研究结果表明，血浆 S1P 是预测肺炎预后的一个有潜力的生物标志物。本研究旨在评估 S1P 和 CRP 对鉴别急诊科（ED）中 COPD 合并肺炎和 AECOPD 的价值。
方法
从万芳医院急诊科招募 AECOPD 或 COPD 合并肺炎患者。ED 入院时收集临床数据、人口统计学和血液样本。通过 ELISA 测定血浆 S1P 浓度。
结果
本观察性研究共纳入 39 例 AECOPD 患者和 78 例 COPD 合并 CAP 患者。与 AECOPD 患者相比，COPD 合并 CAP 患者的血液 S1P 和 CRP 水平显著升高。S1P 和 CRP 区分 COPD 合并 CAP 和 AECOPD 患者的受试者工作特征（ROC）曲线下面积分别为 0.939（95%CI：0.894-0.984）和 0.886（95%CI：0.826-0.945），而 S1P 和 CRP 的联合检测值为 0.994（95%CI：0.897-1.000）。与 CRP 或 S1P 相比，联合 CRP 和 S1P 对区分 COPD 合并肺炎组和 AECOPD 组具有更高的 AUC 值。
结论
我们的研究结果表明，S1P 是区分 COPD 合并 CAP 与 AECOPD 的潜在诊断生物标志物。此外，当 S1P 与 CRP 联合使用时，其诊断能力可以提高。
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