摘要
目的探讨肺泡蛋白沉积症(PAP)患者临床特征与血清肿瘤标志物及乳酸脱氢酶(LDH)的关系。方法回顾性分析广西医科大学第一附属医院2011年4月至2018年5月收治的PAP患者临床资料,分析各项血清肿瘤标志物、LDH水平与血气指标、肺功能、疾病严重程度评分(DSS)的相关性。结果本研究回顾的44例PAP患者中,28例有吸烟史,10例粉尘接触史,1例长期农药接触史,1例喷漆接触史。PAP以进行性呼吸困难为主要临床表现。血清LDH升高37例,癌胚抗原(CEA)升高35例,细胞角蛋白19片段21-1(CYFRA21-1)升高36例,神经元特异性烯醇化酶升高23例,糖类抗原CA15-3升高15例。血清LDH与动脉血氧分压(PaO2)、动脉血氧饱和度、肺一氧化碳弥散量占预计值百分比呈负相关(r=-0.504、-0.490、-0.542,P值均<0.05)。血清CEA水平与PaO2、动脉血氧饱和度及肺一氧化碳弥散量均呈负相关(r=-0.591、-0.478、-0.421,P值均<0.05)。血清CYFRA21-1、CA15-3与PaO2均呈负相关(r=-0.680、-0.544,P值均<0.05)。血清CEA、CYFRA21-1、CA15-3与LDH均呈正相关(r=0.556、0.574、0.534,P值均<0.05)。DSS与LDH、CEA、CYFRA21-1、CA15-3均呈正相关(r=0.389、0.409、0.604、0.490,P值均<0.05)。全身麻醉下肺泡灌洗术后患者PaO2、DSS有显著性改善(t=-2.342、2.668,P值均<0.05)。全身麻醉下肺泡灌洗术后PAP患者血清LDH、CEA、神经元特异性烯醇化酶显著低于术前(P值均<0.05),CYFRA21-1灌洗前后差异无统计学意义(Z=-0.943,P>0.05)。结论烟雾或其他有毒气体或颗粒可能是PAP的诱发因素。血清肿瘤标志物及LDH与疾病的严重程度相关,在临床上动态监测这些指标,建立一个多因素指标模型可评估PAP患者的病情严重程度及疗效。
Objective To investigate the relationship between the clinical characteristics of pulmonary alveolar proteinosis(PAP),serum tumor markers,and lactate dehydrogenase(LDH).Methods The clinical data onto patients with PAP admitted to the First Affiliated Hospital of Guangxi Medical University from April 2011 to May 2018,were retrospectively analyzed.The relationship between blood gases analysis,pulmonary function,disease severity score,serum tumor marker levels were analyzed.Results There were 28 patients had a history of cigarette smoking,10 had dust exposure.One patient had a long history of pesticide exposure and one had spray paint exposure.Progressive dyspnea was the main clinical manifestation.The level of serum carcinoembryonic antigen(CEA)increased to 35 cases,cytokeratin fragment antigen 21-1(CYFRA21-1)in 36 cases,neuron specific enolase in 23 cases,carbohydrate antigen 15-3(CA15-3)in 15 cases.The LDH negatively correlated with arterial partial pressure of oxygen(P a 02),arterial oxygen saturation,diffusing capacity for carbon monoxide(DLC O)%predicted(r=-0.504,-0.490,-0.542,all P<0.05),respectively.The serum level of CEA negatively correlated with P a 02,S a02,and DLCO%predicted(r=-0.591,-0.478,-0.421,all P<0.05).Serum CYFRA21-1 and CA15-3 were negatively correlated with PaO2(r=-0.680,-0.544,both P<0.05).The serum level of CEA,CYFRA21-1 and CA15-3 were positively correlated with LDH(r=0.556,0.574,0.534,all P<10.05).Disease severity scores were positively correlated with CEA,CYFRA21-1 and CA15-3(r=0.389,0.409,0.604,0.490,all P<0.05).The Pa02 and disease severity score of patients were improved significantly after whole lung lavage under general anesthesia(t=-2.342,2.668,both P<0.05).The serum levels of LDH,CEA and neuron specific enolase were significantly lower after whole lung lavage than before surgery(all P<0.05),but CYFRA21-1 was no statistically significant difference before and after whole lung lavage(Z=-0.943,P>0.05).Conclusions Smoking or other toxic gases or particles may be the inducing factors of PAP.Serum tumor markers and LDH can be used as an index to monitor the severity of the disease and evaluate the curative effect.Dynamic monitoring of these indicators in clinic and establishing a multi-factor index model can judge the severity of PAP patients and the therapeutic effect.
作者
潘绵鸾
唐姝丹
曾文
邱晔
何志义
邓静敏
张建全
Pan Mianluan;Tang Shuclan;Zeng Wen;Qiu Ye;He Zhiyi;Deng Jingmin;Zhang Jianquan(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Respiratory Medicine,the Eighth Affiliated Hospital,Sun Yat-Sen University,Shenzhen 518033,China)
出处
《国际呼吸杂志》
2020年第16期1232-1237,共6页
International Journal of Respiration
关键词
肺泡蛋白沉积症
肿瘤标记
生物学
呼吸功能试验
疾病严重程度评分
Pulmonary alveolar proteinosis
Tumor markers,biological
Respiratory function tests
Disease severity score
