论文部分内容阅读
Objectives Detection the serum levels of tumor necrosis factor-α,interleukin-6,platelet-derived growth factor,macrophage inflammatory protein-1α,monocyte chemoattractant protein-1 and interleukin-8 in stage Ι pneumoconiosis patients,suspected silicosis patients,healthy silica dust workers and healthy controls,to explore sensitive and specific early diagnosis of pneumoconiosis by construction ROC curves and compare cytokines the value of screening.We hope that would provide the new method for the early detection of coal workers,pneumoconiosis.Subjects and methods 90 cases of stage Ι pneumoconiosis patients were chosen from Occupational Disease Prevention Hospital of Qianjiaying,diagnosed with pneumoconiosis by the qualified doctor on the basis of the diagnostic criteria of Pneumoconiosis(GBZ70-2009).And choose 180 suspected silicosis patients with small shadow lungs.180 healthy silica dust workers who randomly match the suspected silicosis patients age,have completely normal chest radiograph and 161 healthy controls were not engaged in dust-exposed.Laboratory studies Collected cubital vein 5ml from fasting subjects in the survey informed consent.After1~2h,2000 r/min centrifuged 10 min separation of serum,the serum be stored at-80℃ and discard hemolysis.In strict accordance with MIP-1α,MCP-1,IL-8,TNF-α,IL-6 and PDGF enzyme immunoassay kit manual steps use microplate reader to determine the expression levels of cytokines.The reorganized data input by Microsoft Excel2007 form,used SPSS13.0 statistical analysis statistical analysis software.The quantitative data from a normal distribution,such as age,dust exposure,level of cytokine expression use analysis of covariance and stratified analysis and two categories of qualitative data such as smoking rate analysis use the chi-square test.X-ray as the gold standard,ROC curves was used to evaluate the pros and cons of screening.Results 1 Expression of five cytokines levels in four-group study and the influence on the expression of cytokines levels with seniority: Whether it is smoking or non-smoking group the expression level of five cytokines in patients suffering from coal workers pneumoconiosis were significantly higher than those in suspected silicosis patients,in the exposed group and the healthy control group(P<0.05);Whether it is smoking or non-smoking group the expression level of five cytokines in suspected silicosis patients significantly higher than the healthy control group(P<0.05)and the expression level of IL-8 in suspected silicosis patients significantly higher than those in the exposed group(P<0.05); The expression level of five cytokines in the exposed group who smoking significantly higher than the healthy control group(P<0.05); The expression level of L-8、MCP-1、TNF-α、PDGF in the exposed group who non-smoking significantly higher than the healthy control group(P<0.05).The expression levels of five cytokines had increasing trend increasing length of service(P <0.05).2 The value of different cytokine expression levels screen CWP: With their ROC curve above the reference line,there was statistical significant in area under the curve(AUC)of IL-8、MCP-1、TNF-α、CTGF、PDGF between two groups.;The best critical value of 5 cytokines was 1870.38pg/ml、988.22pg/ml、38.77ng/m、1730.82pg/ml and 178.06ng/ml respectively.With their cut off points,TNF-α was the highest sensitivity(92.2%),the lowest missed rate(7.8%),the lowest negative likelihood ratio(0.08)and the highest negative predictive value(98.0%); MCP-1 was the highest specificity(97.8%),the highest Youden index(87.8%),the lowest rate of misdiagnosis(2.2%),the highest positive likelihood ratio(40.91),the highest consistency rate(96.2%),the highest positive predictive value(91.0%); The Kappa value of these indexes was between 0.41 and 0.88 and MCP-1 was the highest Kappa value 0.88.Conclusions The expression levels of MCP-1,IL-8,TNF-α,CTGF and PDGF in turn increased from healthy controls to stage Ι pneumoconiosis patients.With the increase of length of service,the expression levels of cytokines have increasing trend.With their cut off points,IL-8,MCP-1and TNF-α three indicators can be used as screening CWP indicators and the best critical value was 1870.38pg/ml、988.22pg/ml and 38.77ng/ml respectively.